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Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England
  1. Emmanuel Fru Nsutebu1,
  2. Ana Belén Ibarz-Pavón2,
  3. Elizabeth Kanwar3,
  4. Nancy Prospero3,
  5. Neil French1,2,
  6. Conor McGrath4
  1. 1 Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2 Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
  3. 3 Advancing Quality, Advancing Quality Alliance, Salford, UK
  4. 4 Department of Critical Care Medicine, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
  1. Correspondence to Dr Emmanuel Fru Nsutebu, Tropical and Infectious Disease Unit, Royal Liverpool Hospital, Liverpool L7 8XP, UK; nsutebufru{at}hotmail.com

Abstract

Objective To evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.

Setting 14 hospitals in the northwest of England.

Intervention A quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review.

Main outcome measures Inpatient mortality, 30-day readmission rates and duration of hospital ≥10 days.

Results Data for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69–0.95)) and hospital stays over 10 days (OR 0.69 (0.60–0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59–0.81), OR 0.77 (0.67–0.89) and OR 0.64 (0.54–0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49–0.69), OR0.81 (0.70–0.94) and OR 0.54 (0.45–0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days.

Conclusions The AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.

  • infectious diseases
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Footnotes

  • Contributors EFN, CM and EK designed the programme and study; NP extracted the data; ABI-P performed the analysis; and ABI-P and EFN wrote the first draft of the manuscript. NP, EK, NF and CM contributed to drafting the paper. All authors agreed on the final draft; EFN will act as guarantor of the paper.

  • Funding No specific funding was available for this project. ABI-P is supported in her role by Liverpool Health Partners.

  • Disclaimer The views expressed are those of the authors and not necessarily those of Liverpool Health Partners.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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