Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards
Abstract The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the...
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Nature Portfolio
2021
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oai:doaj.org-article:93298186091d4da7ba07177f7ebc2c312021-12-02T15:07:47ZFour consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards10.1038/s41598-021-95648-62045-2322https://doaj.org/article/93298186091d4da7ba07177f7ebc2c312021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-95648-6https://doaj.org/toc/2045-2322Abstract The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice. Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.Maja KopczynskaHarry UnwinRichard J. PughBen SharifThomas ChandyDaniel J. DaviesMatthew E. ShieldDavid E. PurchaseSamuel C. TilleyArwel PoacherLewis OlivaSam WillisIsabelle E. RayJohn Ng C. HuiBethany C. PayneEilis F. WardleFiona AndrewHei Man Priscilla ChanJack BarringtonJay HaleJoanna HawkinsJess K. NicholasLara E. WirtLowri H. ThomasMegan WalkerMyat P. PanTallulah RayUmair H. AsimVictoria MaidmanZeid AtiyahZain M. NasserZhao Xuan TanLaura J. P. TanTamas SzakmanyThe Welsh Digital Data Collection Platform collaboratorsNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021) |
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DOAJ |
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Medicine R Science Q |
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Medicine R Science Q Maja Kopczynska Harry Unwin Richard J. Pugh Ben Sharif Thomas Chandy Daniel J. Davies Matthew E. Shield David E. Purchase Samuel C. Tilley Arwel Poacher Lewis Oliva Sam Willis Isabelle E. Ray John Ng C. Hui Bethany C. Payne Eilis F. Wardle Fiona Andrew Hei Man Priscilla Chan Jack Barrington Jay Hale Joanna Hawkins Jess K. Nicholas Lara E. Wirt Lowri H. Thomas Megan Walker Myat P. Pan Tallulah Ray Umair H. Asim Victoria Maidman Zeid Atiyah Zain M. Nasser Zhao Xuan Tan Laura J. P. Tan Tamas Szakmany The Welsh Digital Data Collection Platform collaborators Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| description |
Abstract The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice. Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016. |
| format |
article |
| author |
Maja Kopczynska Harry Unwin Richard J. Pugh Ben Sharif Thomas Chandy Daniel J. Davies Matthew E. Shield David E. Purchase Samuel C. Tilley Arwel Poacher Lewis Oliva Sam Willis Isabelle E. Ray John Ng C. Hui Bethany C. Payne Eilis F. Wardle Fiona Andrew Hei Man Priscilla Chan Jack Barrington Jay Hale Joanna Hawkins Jess K. Nicholas Lara E. Wirt Lowri H. Thomas Megan Walker Myat P. Pan Tallulah Ray Umair H. Asim Victoria Maidman Zeid Atiyah Zain M. Nasser Zhao Xuan Tan Laura J. P. Tan Tamas Szakmany The Welsh Digital Data Collection Platform collaborators |
| author_facet |
Maja Kopczynska Harry Unwin Richard J. Pugh Ben Sharif Thomas Chandy Daniel J. Davies Matthew E. Shield David E. Purchase Samuel C. Tilley Arwel Poacher Lewis Oliva Sam Willis Isabelle E. Ray John Ng C. Hui Bethany C. Payne Eilis F. Wardle Fiona Andrew Hei Man Priscilla Chan Jack Barrington Jay Hale Joanna Hawkins Jess K. Nicholas Lara E. Wirt Lowri H. Thomas Megan Walker Myat P. Pan Tallulah Ray Umair H. Asim Victoria Maidman Zeid Atiyah Zain M. Nasser Zhao Xuan Tan Laura J. P. Tan Tamas Szakmany The Welsh Digital Data Collection Platform collaborators |
| author_sort |
Maja Kopczynska |
| title |
Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| title_short |
Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| title_full |
Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| title_fullStr |
Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| title_full_unstemmed |
Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards |
| title_sort |
four consecutive yearly point-prevalence studies in wales indicate lack of improvement in sepsis care on the wards |
| publisher |
Nature Portfolio |
| publishDate |
2021 |
| url |
https://doaj.org/article/93298186091d4da7ba07177f7ebc2c31 |
| work_keys_str_mv |
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