‘The golden hour’ : Diagnosing and treating life-threatening sepsis within an hour

The draft NICE guidance, commissioned by the Department of Health and due to be published in August 2017, puts renewed emphasis on the need for urgency in recognising and treating sepsis in order to save the lives of thousands of patients a year.

Sepsis, also known as septicaemia or blood poisoning is a serious and life-threatening condition requiring prompt identification and rapid treatment.

It arises when the body has an ‘abnormal’ response to a ‘normal’ infection, forcing the immune system into overdrive and damaging tissue and organs. This can lead to septic shock, multiple organ failure, disability and death, particularly where there is a delay in diagnosis and/or delayed administration of treatment. Arising from an infected site in the body (either localised or widespread), sepsis commonly occurs following chest or urine infections, bowel perforation and severe skin infections, but can also present after simple skin injuries such as cuts and bites.

The reality of late treatment in cases of severe sepsis makes for tragic reading, with the UK Sepsis Trust estimating around 37,000 deaths from sepsis in the UK every year.

Learning lessons

Just last month, Jeremy Hunt, UK health secretary attended the private memorial service of William Mead to apologise on behalf of himself, the government and the NHS for the string of failures which lead to the devastating and preventable death of the 1 year old. William’s GP, out-of-hours services and a 111 call-handler all failed to diagnose sepsis, which had developed as a result of an underlying chest-infection and pneumonia.

William’s mother, Melissa Mead has become a prominent campaigner to raise awareness and to bring about change in the health service, campaigning for health professionals to ‘Think Sepsis’ when assessing a patient with presenting symptoms.

Red flags and the ‘Sepsis Six’

An NHS England report into William Mead’s death found there were four missed opportunities to have saved his life. The report found 16 mistakes which contributed to his death, and critically that the out-of-hours 111 tick box system used by call-handlers failed to include sepsis ‘red flags’.

Because sepsis is a variable condition affecting more than one organ, the characteristics can differ, from mild feelings of general sickness, to cold shivers, a high temperature, rapid heart rate and breathlessness.

When assessing a patient with presenting symptoms, health professionals should be alert for the ‘Sepsis Six’, undertaking the following six simple steps which – if taken within ‘the golden hour’ – could double a patient’s chance of survival :

• Administer oxygen
• Test blood for infection
• Give antibiotics
• Give intravenous fluid
• Measure serum lactate and haemoglobin
• Measure hourly urine output

Failures in recognising and treating sepsis

Unfortunately, my colleagues and I are all too often involved in cases where medical professionals have failed to properly manage a patient with sepsis.

Warning signs can sometimes be confused for ‘flu’ symptoms, and whilst for some healthcare professionals (particularly in tertiary units) sepsis may be an unusual event, their prompt suspicion of the diagnosis will be critical to the patient’s recovery. With shortages of medical staff in hospitals, inadequate management strategies and pressure on doctors not to prescribe antibiotics, symptoms are often being overlooked.

In 2015, an inquiry found that 40% of patients with sepsis who arrived at A&E were not reviewed by senior doctors quickly enough, and there were avoidable delays in administering IV fluids and antibiotics in nearly a third of cases.

I am pleased to see the proposed NICE guidance highlighting the urgency of recognising and treating sepsis. The guidance should help to promote early recognition and swift treatment of patients’ presenting symptoms, ensuring they stand the best possible chance of making a full recovery and avoiding tragedies like the death of baby William Mead.