Sepsis is a common cause of serious illness and death with an estimated 123,000 cases and
46,000 deaths in the UK each year. Similarly, high levels of sepsis have been reported
internationally, and sepsis is recognised by the World Health Organisation as a global
health priority. Many countries have nationwide sepsis action plans and all UK hospitals
have set targets to rapidly diagnose and treat patients with sepsis. Timely appropriately
targeted intravenous antibiotics have been shown to be effective in improving outcomes
for patients, with a 4% increase in odds of mortality for every hour's delay in
administration of intravenous antibiotics.
The need for rapid treatment has led to the development of clinical criteria and
'screening tools' have been proposed to identify patients with sepsis. These include
Sequential (Sepsis related) Organ Failure Assessment (Sofa), Systemic Inflammatory
Response Syndrome (SIRS) criteria and in England the National Early Warning Score (NEWS),
which was developed by the UK Royal College of Physicians. In December 2017, an updated
version of NEWS, NEWS2 was published, which is recommended by NICE and the Royal College
of Physicians as the most effective screening tool for sepsis in the UK. Available tools
are based on current observations which clinicians are able to take and quickly calculate
a score, but there is a paucity of evidence as to which tool to use and their effect on
patient outcomes.
Potential pathways for the effectiveness of alerts when clinical deterioration is due to
sepsis are likely to include an increase in the proportion of patients receiving
intravenous antibiotics in one hour, and other 'sepsis six' measures. Improved
communication and changes in dialogue between healthcare teams has been suggested as an
important pathway for improvements in clinical outcomes. In addition, the introduction of
sepsis alerts is often accompanied by treatment plans as well as education and training
activities. Little is known about the contribution of these and other potential mediators
on the effectiveness of alerts.
Previous qualitative research with healthcare professionals has highlighted problems in
identification and management of sepsis including limits in professionals' capacity to
identify sepsis, difficulties in handover of patients and errors in communication. These
studies highlight both the requirement for healthcare professionals to feel confident in
their assessment of patients and for clinical and organisations structures to work
efficiently to provide optimal patient care. Previous qualitative research with patients
has reported on patients' decisions to seek help with symptoms, experiences of
hospitalisation and how patients have managed life after surviving sepsis. Additional
studies with caregivers have described the burden on those caring for sepsis survivors
and their role in advocating for their loved ones. Another study has looked at the words
patients and call handlers use to describe symptoms of sepsis when patients seek help.
These topics can help inform how patients and clinicians could use and potentially
benefit from the use of digital alerts in hospitals.
This study is part of a wider programme of work seeking to determine the effectiveness of
the introduction of digital alerts to improve outcomes of patients with sepsis. This
component of the work seeks to explore healthcare professionals' and patients'/family
members' views and experiences of deteriorating patient/sepsis alert systems in
hospitals. This work will be undertaken within at least some of the NHS Trusts involved
in the wider programme of work (Royal Berkshire NHS Foundation Trust, Oxford University
Hospitals NHS Foundation Trust, University College London Hospitals NHS Foundation Trust,
Imperial College Healthcare NHS Trust, Chelsea and Westminster Hospital NHS Foundation
Trust and Cardiff & Vale University Health Board) and potentially additional Trusts if
required.
This is a qualitative study which includes three methods of data collection; observation
of healthcare professionals working in hospitals, one-to-one interviews with healthcare
professionals and interviews/focus groups with patients/family members.
Healthcare professionals will include doctors, nurses and other professionals who use, or
help implement, deteriorating patient/sepsis alerts in NHS hospital Trusts.
Patients/family members will include patients recruited from NHS trusts and community
settings, who have previously had sepsis or are family members of patients who have had
sepsis.
Interviews and focus groups will include topics which may be upsetting for some
patients/family members or healthcare professionals. All participants will be made aware
of sources of support available to them through the NHS and other relevant organisations.
Patients and family members will have the option of taking part in a focus group or an
individual interview depending on what they feel comfortable with.