Sepsis: A quality improvement methodology

NICE describes Sepsis as “a clinical syndrome caused by the body’s immune and coagulation systems being switched on by an infection.”1 Sepsis with shock is a life-threatening condition, characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. Both a UK Parliamentary and Health Service Ombudsman enquiry (2013) and a UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined.

Sepsis is notoriously difficult to diagnose with certainty and, although people with sepsis may have a history of infection, fever is not present in all cases. Therefore signs and symptoms can be very non-specific and can be missed if clinicians do not think: “Could this be sepsis?” In the same way that healthcare professionals consider: “Could this pain be cardiac in origin?” when presented with someone of any age with chest pain. A programme at Great Ormond Street Hospital (GOSH) aims to make: “Could this be sepsis?” the first consideration for anyone presenting with a possible infection. 

Detailed guidelines exist for the management of sepsis in adult and paediatric intensive care units, and by intensive care clinicians called to other settings. To reduce avoidable deaths, people with sepsis need to be recognised early and treatment initiated. Ultimately healthcare systems in all clinical settings should aim to ensure that sepsis is considered as an immediate life-threatening condition that should be recognised and treated as an emergency.1