Sepsis in Wales on the general wards: results of a feasibility pilot

Abstract

, epidemiologic information on sepsis is limited. Whilst about 30% of all ICU patients in the UK have severe sepsis, there are no data published on the incidence of sepsis on the general wards in Wales, or indeed in the rest of the UK. 1 It has been suggested that delivering six simple interventions, the 'Sepsis 6' bundle, within 1 hour of recognition of sepsis may improve outcome on the general ward setting. 2 3

Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

“…These results confirm our previous findings in the feasibility pilot [3]. There are many possible reasons for this disappointing result.…”

“…Our methods allowed us to strictly follow the guidance for sepsis screening and this increased scrutiny is probably responsible for many of the sepsis cases discovered. As detection of the syndrome was low during usual clinical care, it is unsurprising, that the Sepsis 6 bundle has only been applied in ad-hoc manner [3]. It has been shown previously that improving the detection, raising awareness of the problem and concentrated efforts to improve basic sepsis care can lead to significant mortality reduction, even if bundle compliance remains low [18].…”

“…We have described a cohort of patients with sepsis and severe sepsis, who can be identified in EDs and general wards in the UK and in Western Europe. We have previously described our methods in our feasibility study and the evidence based bundle elements have been implemented in all participating centers through the 1000 Lives quality improvement initiative [3,7]. We were then able to collect data describing compliance with these metrics and also data describing presentation patterns and severity of these patients.…”

“…However, accurate data collection in the non-Critical Care setting is still under development in Wales and it is thought that the real number is likely to be far higher [3]. Sepsis is a major cause of avoidable mortality and it is imperative that we understand the size of the problem within Wales so that we can improve the quality of care received by our patients.…”

“…Of the 51 patients with sepsis, critical care clinicians saw only seven, of which two patients were admitted to the ICU. Three patients received the full Sepsis 6 bundle within 1 hour [3]. The new sepsis definitions were published in 2016, which potentially has changed the baseline for sepsis incidence, essentially removing the “severe sepsis” category.…”