The consequences of failure to diagnose and treat sepsis

Sepsis is a potentially life threatening condition, triggered by an infection or injury. The body’s immune system goes into overdrive as it tries to fight an infection, but this over reaction leads to an attack on the body by reducing the blood supply to vital organs such as the brain, heart and kidneys.

If diagnosed early sepsis can be treated with antibiotics. But without quick treatment, it can lead to multiple organ failure and death.

A recent report by The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) estimated that in the UK 37,000 patients die with sepsis each year. A further estimate of 65,000 people a year survive episodes of severe sepsis, often with serious long-term consequences such as amputation, muscular contraction and irreversible damage to major organs. Early recognition is therefore vital.

The NCEPOD report looked into the care pathways, processes and organisational structure of all those involved in the recognition of sepsis, from admission through to discharge or possibly death. Its objective was to identify avoidable and remedial factors in the management of care of adult patients with it.

Some of its findings were worrying. For example over 30% of hospitals involved in the study had no formal sepsis protocol, but the majority of these did have protocols to identify when a patient is deteriorating.  In those cases assessed by GPs prior to admission, a diagnosis of sepsis was missed in over 35% of cases. The report identifies that where there were delays in admission to hospital, in a large proportion of the cases this was due to the patient not seeking help early enough.

The study was carried out in May 2014. It was published in Nov 2015 and concluded with a  comprehensive list of recommendations in improving the diagnosis and treatment of sepsis.  NHS England identified tackling it as a clinical priority for improving patient outcomes for 2015/16.

In January 2016 the Health Secretary Jeremy Hunt made a public apology to the family of William Mead, a one year old who died after failures by the NHS on several occasions to detect and treat his sepsis.

Given the importance of early recognition and treatment, it is clear that there is scope for improvement in this area.