The fact that sepsis continues to tragically affect lives was again highlighted in the recently reported case of Tristan Rosevear who was left with brain damage after an opportunity to promptly treat a septic hip was missed. This led to septic shock and Mr Rosevear suffered multiple organ failure. The UK Sepsis Trust are trying to raise awareness and implement changes in medical practice to bring down both the death rate and also the risk of patients being left with significant disability.
Having dealt with medical negligence cases arising from sepsis, the most tragic aspect of these cases is that prompt and rigorous treatment with antibiotics would most often have left the person with no residual disability. There is no need for complicated surgical or medical techniques which may not be available in every district general hospital. The treatment often is relatively simple and commonly available. So why are cases of sepsis missed? Often it is in the community with GPs not recognising the need for admission to hospital so that intensive antibiotics and other treatment can be given. Another situation where sepsis is often missed or not acted on promptly is in A&E.
Infections are common and are often treated by oral antibiotics prescribed by the GP. However the situation can become life threatening when the body overreacts to an infection resulting in sepsis. This can happen whatever the underlying cause of the infection whether this is pneumonia, urinary infections, wound infections, etc. Time is of the essence when treating sepsis. The problem is often in promptly identifying and responding to the clinical signs which demonstrate that a person has sepsis.
Is this a silent condition or are there signs that can be recognised and should be responded to? Research has identified that there are signs and symptoms (e.g. respiratory rate > 25 per minute, lactate > 2mmol/l, etc) which are commonly found in patients with evolving sepsis. This has led the UK Sepsis Trust to develop an 'Emergency Department Sepsis Screening and Action Tool' so that even junior doctors know what they need to look for to alert them to the patient potentially having sepsis. There are two aspects to the tool – firstly, recognition and secondly, and perhaps most importantly, action. This requires the doctor to assume that the patient has severe sepsis in response to 'Red Flag Sepsis' signs being identified and to respond with immediate action steps identified as the 'Sepsis Six'. These six steps include the giving of intravenous antibiotics, high-flow oxygen and fluids promptly – the goal being within one hour.
Every patient should have the right to have prompt recognition and treatment of their sepsis. However it also makes sense for the NHS to put that into practice. The pressure on intensive care beds, ward beds being occupied for longer, the need for rehabilitation, etc are all potential consequences of not giving treatment promptly and this places both a financial and practical burden on the NHS.
The UK Sepsis Trust notes the research identified that:
- 'For each hour's delay in administering antibiotics in septic shock, mortality increases by 7.6%'
The 'Sepsis six' is becoming a recognised tool to be used in bringing down the number of patient deaths. These life saving measures proposed by the Sepsis Trust will hopefully result in significant improvement in death rates in the future. However it seems that it is still early days in terms of seeing any real change in the number of lives saved. That real change will be seen when the theory is put into practice in day to day medical care. The Sepsis Trust have been working with the College of Emergency Medicine to promote the 'Sepsis six' in clinical care and in particular in giving antibiotics within an hour to patients with severe sepsis and septic shock. However, it appears only a fraction of patients received antibiotics within this timescale. It can only be hoped that that will change in the future.
If you or a family member have been affected by sepsis and you wish to discuss whether there are issues in the medical care that was given whether by a GP or hospital then please contact our team.