John Burke1, Sally Wood2,3, Andrew Hermon2, Tamas Szakmany2,4,5. 1. ACT Directorate, Cwm Taf University Health Board, Royal Glamorgan Hospital, Llantrisant, UK. 2. Cwm Taf University Health Board, Royal Glamorgan Hospital, Llantrisant, UK. 3. QMC, Nottingham University Hospitals, Nottingham, UK. 4. Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Heath Park Campus, Cardiff, UK. 5. Critical Care Directorate, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.
Abstract
BACKGROUND: The Sepsis Six bundle is designed to facilitate early intervention with three diagnostic and three therapeutic steps to be delivered within 1 h to patients with suspected sepsis. AIMS AND OBJECTIVES: To investigate the effects of delivering the 'Sepsis Six' bundle by the Critical Care Outreach team on patient outcomes. DESIGN: In a prospective observational study, all adult patients on the general wards from June 2012 to January 2014 with sepsis who were screened and treated by the Critical Care Outreach team were included. METHODS: The main outcome measure was the change in National Early Warning Score following the delivery of the Sepsis Six bundle within 24 h. Secondary outcomes were 90-day mortality and overall bundle compliance. RESULTS: A total of 207 patients were included in the analysis. Overall bundle compliance was 84%. National Early Warning Scores decreased significantly 24 h after administering the Sepsis Six, from 7·4 ± 2·6 to 3·1 ± 2·4 (p < 0·001). The distribution of the National Early Warning Score changed significantly. Mortality was lower at 90 days when patients who presented with signs of sepsis within 48 h of hospital admission were compared with those who presented with signs of sepsis after 48 h of hospital admission (14·5% versus 35·4% p < 0·03) despite similar baseline physiological variables. CONCLUSIONS: We found better outcomes after the administration of Sepsis Six. Reliable delivery of the bundle, defined as 80% of patients receiving the standard of care, is achievable, and our quality improvement data suggest that it is likely to be sustainable in our environment. RELEVANCE TO CLINICAL PRACTICE: Sepsis Six can reduce physiological impairment, monitored by the National Early Warning Scores. Consistent delivery of the bundle can lead to better patient outcomes.
BACKGROUND: The Sepsis Six bundle is designed to facilitate early intervention with three diagnostic and three therapeutic steps to be delivered within 1 h to patients with suspected sepsis. AIMS AND OBJECTIVES: To investigate the effects of delivering the 'Sepsis Six' bundle by the Critical Care Outreach team on patient outcomes. DESIGN: In a prospective observational study, all adult patients on the general wards from June 2012 to January 2014 with sepsis who were screened and treated by the Critical Care Outreach team were included. METHODS: The main outcome measure was the change in National Early Warning Score following the delivery of the Sepsis Six bundle within 24 h. Secondary outcomes were 90-day mortality and overall bundle compliance. RESULTS: A total of 207 patients were included in the analysis. Overall bundle compliance was 84%. National Early Warning Scores decreased significantly 24 h after administering the Sepsis Six, from 7·4 ± 2·6 to 3·1 ± 2·4 (p < 0·001). The distribution of the National Early Warning Score changed significantly. Mortality was lower at 90 days when patients who presented with signs of sepsis within 48 h of hospital admission were compared with those who presented with signs of sepsis after 48 h of hospital admission (14·5% versus 35·4% p < 0·03) despite similar baseline physiological variables. CONCLUSIONS: We found better outcomes after the administration of Sepsis Six. Reliable delivery of the bundle, defined as 80% of patients receiving the standard of care, is achievable, and our quality improvement data suggest that it is likely to be sustainable in our environment. RELEVANCE TO CLINICAL PRACTICE: Sepsis Six can reduce physiological impairment, monitored by the National Early Warning Scores. Consistent delivery of the bundle can lead to better patient outcomes.
Authors: Maja Kopczynska; Ben Sharif; Harry Unwin; John Lynch; Andrew Forrester; Claudia Zeicu; Sian Cleaver; Svetlana Kulikouskaya; Tom Chandy; Eshen Ang; Emily Murphy; Umair Asim; Bethany Payne; Jessica Nicholas; Alessia Waller; Aimee Owen; Zhao Xuan Tan; Robert Ross; Jack Wellington; Yahya Amjad; Vidhi Unadkat; Faris Hussain; Jessica Smith; Sashiananthan Ganesananthan; Harriet Penney; Joy Inns; Carys Gilbert; Nicholas Doyle; Amit Kurani; Thomas Grother; Paul McNulty; Angelica Sharma; Tamas Szakmany Journal: J Clin Med Date: 2019-08-29 Impact factor: 4.241