Sepsis Kills program - saving lives in NSW

An early intervention program designed to improve the way emergency departments deal with patients with sepsis has been successful in speeding up the process of treating the potentially fatal condition, according to research published online by the Medical Journal of Australia.
Sepsis is one of the most common causes of clinical deterioration, and was involved in 17.5% of in-hospital deaths in NSW in 2009, compared with a mortality of 1.5% for all hospital separations, according to Mary Fullick, Sepsis Program Lead at the Clinical Excellence Commission (CEC) in Sydney, Professor Mary-Louise McLaws, at the University of New South Wales, and colleagues.
“SEPSIS KILLS is a quality improvement program that aims to reduce preventable harm to patients with sepsis by recognising the condition early and managing it promptly…based on the principle that early recognition and aggressive management with antibiotics and fluids will improve outcomes,” the authors wrote.
The program was introduced into NSW emergency departments from 2011, and data from 13 567 patients were collected for the period 2011–2013.
“The focus of the program is to recognise risk factors, signs and symptoms of sepsis; resuscitate with rapid intravenous fluids and antibiotics; and refer to senior clinicians and teams. Sepsis is a medical emergency and simple treatment saves lives,” the authors explained.
The researchers found the proportion of patients receiving intravenous antibiotics within 60 minutes of triage increased from 29.3% in 2009–2011 to 52.2% in 2013; the percentage for whom a second litre of fluid was started within 60 minutes rose from 10.6% to 27.5%. The research shows the number of sepsis patients being treated immediately (Triage 1, 2.3% in 2009 to 4.2% in 2013) or within 10 minutes of arrival (Triage 2, 40.7% in 2009 to 60.7% in 2013) has increased. At the same time, there was a decrease in mortality from 19.3% in 2009–2011 to 14.1% in 2013, and there were also significant declines in time in intensive care and total length of stay.
The research also shows the proportion of patients with uncomplicated sepsis transferred to a ward increased. The mortality rate after transfer increased from 3.2% in 2009–2011 to 6.2% in 2013. This highlighted the need for a shift in the focus of both practice improvement and research from intensive care to ward management. Since the conclusion of the research, NSW public hospitals have begun extending the SEPSIS KILLS program to inpatient areas and introduced a 48-hour management plan for ward patients.
“The SEPSIS KILLS program promotes early recognition and management of sepsis during the first few hours in NSW emergency departments. By focusing on the principles of “Recognise, Resuscitate, Refer” it is possible to reduce the time it takes to start antibiotics and fluid resuscitation. This program could be applied in other jurisdictions and its integration with antimicrobial stewardship requirements should be considered,” the researchers concluded.
Reference
Burrell A et al. Sepsis Kills - Early Intervention Saves Lives. MJA 204 (2). 1 Feb 2106.