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Patients lives are being put at risk by sepsis delays, figures suggest

This article was taken from: https://www.telegraph.co.uk/news/2019/07/04/patients-lives-put-risk-sepsis-delays-figures-suggest/

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Patients’ lives are being put at risk with one in four of those with suspected sepsis forced to wait too long for treatment, an investigation has found.

Hospitals are meant to put patients on an antibiotic drip within an hour when sepsis is suspected – but figures from 100 NHS trusts in England suggest thousands of cases are waiting longer.

Dr Ron Daniels, of the UK Sepsis Trust, said the figures showed patients were being put at risk.

Dr Daniels said the one-hour window was “essential to increase the chances of surviving”.

Sepsis | Know the signs

  • Sepsis strikes around 250,000 people in the UK every year, and kills at least 50,000 – more than bowel, breast and prostate cancer combined.
  • It occurs when an infection – usually a bacterial infection – enters the body and the immune system over-reacts, attacking its own tissues and major organs. Unless treated promptly with fluids and antibiotics, this can lead to multiple organ failure. For every hour of delay, a patient’s chance of dying increases by 8 per cent.
  • Sepsis can start as a result of a seemingly minor infection, such as a simple skin cut or bite, a chest or urine infection or even a sore throat, and the problem is often misdiagnosed.
  • Early signs may include a high or low body temperature, chills and shivering and a raised heartbeat. This may develop to dizziness, nausea or vomiting, slurred speech, severe muscle pain, severe breathlessness, not passing urine for a day, cold, clammy and pale skin. If any of these signs are accompanied with any sign of infection or injury, seek medical attention immediately.
  • Anyone can develop sepsis but the very young or very old are particularly vulnerable, as are people with weakened immune systems, people who have recently had surgery or who are already in hospital with a serious illness.

The Sepsis Trust believes there are about 250,000 cases every year in the UK – and more than 50,000 deaths.

NHS England said hospitals were getting better at identifying cases sooner.

The research, by the BBC, comes three years after hospitals in England were instructed to record their identification and treatment of sepsis.

They show that around 75 per cent of patients got treatment within an hour between January and March, as is recommended.

But at some hospitals more than half of patients waited longer.  At Salford Royal NHS trust just 36 per cent of cases were seen in an hour, with just 42 per cent seen within this timescale at Royal Bournemouth and Christchurch Hospitals, and 50 per cent achieving the target at Bradford Teaching Hospitals trust.

Performance on wards and in Accident & Emergency departments was similar, but A&E departments have shown some improvements since 2017, when about 60 per cent of patients began antibiotics within an hour.

In Wales, 71 per cent of A&E patients and 83 per cent of hospital patients had antibiotics within an hour, the investigation found.

Why is the NHS under so much pressure?

  • An ageing population. There are one million more people over the age of 65 than five years ago. This has caused a surge in demand for medical care
  • Cuts to budgets for social care. While the NHS budget has been protected, social services for home helps and other care have fallen by 11 per cent in five years. This has caused record levels of “bedblocking”; people with no medical need to be in hospital are stuck there because they can’t be supported at home
  • Staff shortages. While hospital doctor and nurse numbers have risen over the last decade, they have not kept pace with the rise in demand. Meanwhile 2016 saw record numbers of GP practices close, displacing patients on to A&E departments as they seek medical advice
  • Lifestyle factors. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Growing numbers of overweight children show this problem is currently set to continue

Sepsis is a deadly overreaction of the immune system, in response to infections, which can start from even the most minor injury, such as a contaminated cut.

Normally, the immune system kicks in to fight an infection. But if it spreads, the immune system launches a major response, which can have catastrophic effects, leading to septic shock, organ failure and death.

Hospitals have been given detailed guidance on how to monitor and treat patients, but symptoms are  hard to spot.

Celia Ingham Clark, from NHS England, said medics needed to ensure drugs went to the right patients, following clear screening protocols.

She said: “It’s important not to automatically give antibiotics to everyone, instead we want to identify the sickest patients and get them assessed and then quickly give them antibiotics.”

Simon Smith, 51, went to the A&E department at Russells Hall Hospital, in Dudley, West Midlands, with pain in his leg, last July.

Despite deteriorating rapidly, with a high temperature and heart rate, it was six days before he was given antibiotics to treat sepsis.

He fought the infection for four months, before it killed him.

His widow, Hayley, said: “I am just so angry about the delay giving him antibiotics – that could have made all the difference.

“He had all the signs.

“I’ve seen notes acknowledging he should definitely have had them on day two – but it didn’t happen.”

Dudley Group NHS Trust, which runs the hospital, said it had offered its “heartfelt condolences” to his family.

It said it recognised there were “areas of learning” from the case but could not comment further until the inquest into his death had been held.