When I worked in a Neonatal Intensive Care Unit (NICU), a full term baby was admitted because of rapid deterioration in his condition due to sepsis. As we prepared to resuscitate the little boy the consultant, attempting to encourage us, cried: “Come on, we won’t lose this one.”
He was wrong. In a matter of minutes this newborn baby, who had only a few hours before been thriving, was dead. I was struck then by how quickly sepsis kills and also the futility of leaving treatment too late.
I wouldn’t claim that it was this incident alone which motivated me to take on my role with the Rapid Response to Acute Illness Learning Set (RRAILS), but it was certainly the start of my appreciation of the devastating problem which acute deterioration and sepsis in particular present to patient safety.
Whereas sepsis, which is the body’s reaction to infection rather than the infection itself, is relatively rare in NICUs it is responsible for about 30 per cent of adult ICU admissions. Every ICU nurse or doctor can recount dozens of episodes of potentially preventable, and therefore tragic, deaths. Annual UK mortality from sepsis is estimated at 37,000 people, more than for any single cancer, at a cost to the NHS of £2.5 billion.
It is the survivors of sepsis for whom the side effects can be chronically debilitating. I remember vividly a two year old girl who lost most of her fingers and toes due to the necessary aggressive treatment and whose parents were nevertheless profoundly grateful that their daughter was still alive.
Although sepsis accounts for almost 50 per cent of ICU bed days it need not and, I would argue, should not be seen as an ICU problem. We know that a significant proportion of the deaths and misery that sepsis creates could be avoided by rapid detection and treatment with simple measures delivered in the ward area.
I don’t believe that enabling clinicians to deliver these simple interventions necessarily requires more education, large expense, or heroic effort on the part of NHS staff. Heroism has already become the default delivery method in many parts of the NHS and I would argue for a concentration on the reliable implementation of the mundane, basic elements of care and treatment that are otherwise taken for granted.
My personal definition of reliability in healthcare is ‘doing the right thing, for every patient, every time’. The aim of RRAILS is to support clinical teams to demonstrate that they are doing the simple things, like observations, handover, escalation and primary response reliably.
One of the first steps in improving reliability is to ensure that we are all speaking the same language. In Wales we have gone some way to achieving this common language by introducing the National Early Warning Score (NEWS) in all hospitals.
We also work better when we combine our efforts in a common cause. I was proud of the Welsh teams’ response to the first World Sepsis Day last year and the way it was prominently featured in the launch issue of the Global Sepsis Alliance (GSA) newsletter this week.
Since leaving clinical practice, I have often had difficulty describing succinctly what it is I now do for a living. When my 11 year old daughter asked me recently “What is it again that you do exactly?” I simply said that I try to stop people dying unnecessarily.
She responded that it should be obvious to everyone that this was a good idea. “Well, you’d think so,” I said. “Wouldn’t you?”
Chris Hancock is the Programme Manager for the Rapid Response to Acute Illness Learning Set (RRAILS) programme and the Wales’ lead for World Sepsis Day.