There are an estimated 30 million cases of sepsis every year and sepsis is the 2nd cause of death worldwide and number one cause of preventable death. It is responsible for 6-8 million deaths worldwide and at least 1 million are preventable. It is the 3rd leading cause of maternal mortality (11% of maternal deaths). Pneumonia, malaria and diarrhoeal illnesses are the most important causes of infant mortality (90% as a result of sepsis). One in ten patients are affected by healthcare associated infections.
Though data is limited in regards to the actual burden of sepsis in LMIC, it is estimated to be higher than in HIC due to the higher prevalence of infectious diseases. Data also suggests that morbidity and mortality is higher in LMIC due to limitations in structural, organizational and human resources. Management of sepsis is largely based on clinical trials, research and improvement efforts from resource rich countries; though many efforts are ongoing to adapt international guidance (such as the Surviving Sepsis Campaign 2016) to more resource limited settings and as well to study management interventions in LMIC.
Is sepsis a medical emergency?
Yes, sepsis is a medical emergency. Once a patient with sepsis is recognized, the clock has started to tick. It has been well proven, that early identification and appropriate treatment saves lives. In general, high quality sepsis care involves the following:
- Early recognition and triage.
- Early application of infection prevention and control intervention.
- Early administration of appropriate antimicrobial therapy.
- Early application of safe, live-saving supportive care (includes monitoring).
- Systematic monitoring and reporting of performance indicators to ensure quality care is being delivered.
Why is it important to you?
Improving sepsis care is an integral part of strengthening healthcare systems. A programmatic approach to sepsis improvement will do the following:
- Reduce mortality in your hospital.
- Strengthen the health care system and services.
- Improve management and outcomes for severely ill patients in your hospital.
- Save money and provide cost efficient care.
- Improve the reputation of your hospital.
- Improve staff skills and satisfaction.
- Improve infection prevention/control and reduce healthcare associated infections.
- Contribute to delivering sustainable development goals.
How to use a quality improvement approach to improve sepsis care in your hospital?
Identify key stakeholders and choose a team leader
- Choose a team leader that is well respected, a content expert, a good listener and an enthusiastic champion of the cause.
- Create a team that will lead the improvement efforts. The team should consist of stakeholders, meaning people representing various groups that will be involved and/or support who are needed to make sustained improvements. Team members may include the following:
- Clinicians, such as doctors (emergency physicians, intensivists, surgeons, infectious disease specialists, obstetricians, paediatricians, primary care providers), and other health care workers such as nurses, mid level providers (physician assistants, nurse practitioners), infection prevention specialists, laboratory specialists, microbiologists, pharmacists, physical therapists, and dieticians.
- Non-clinicians, such as audit clerks, information technicians, waste management, security officers, database managers.
- Administrators and managers, including those responsible for budgets and purchasing of equipment and supplies for the hospital.
- Lay people, such as former patients (sepsis survivors) or relatives.
What is the current "reality" of sepsis care?
It is important to understand the current processes of sepsis care in your health care system. In doing so, you will identify challenges and contributing factors for inadequate sepsis care and these will become opportunities for improvement. It is important to consult clinical staff and especially senior clinicians who are at the frontline of care to understand the current processes and obstacles to care.
For example, some of the gaps you may identify include:
- Staff may not understand what sepsis is and how to recognise and treat sepsis.
- Staff may also not be supported to identify patients with sepsis because of their workload, lack of medicine and equipment or senior clinician supervision.
- Staff may be unaware that certain interventions, if initiated early, could save their patient's life.
To understand the workflow involved in caring for patients with sepsis it is important to use standardized tools such as process mapping, fishbone diagrams, and driver diagrams to dissect the work flow in a systematic way (see Appendix A). Patients with sepsis can present at the pre-hospital setting (primary health center, ambulance services) or hospital setting. At the pre-hospital setting, a patient with sepsis must be recognized early, treated promptly if they have emergency signs and then transported safely to a hospital. At the hospital setting, patients with sepsis may present to the emergency department or develop sepsis while on the hospital ward or ICU. Thus, there are many opportunities in the daily workflow of the primary health center, emergency departments, hospital wards and ICU in which you can make an intervention to improve sepsis care. The team of stakeholders will determine where to focus the efforts initially and then how to evolve.