Sepsis Management: Why Early Recognition Is Still So Difficult

The future of sepsis management: is “tick box” medicine really the answer?

This summer, NHS England (NHSE) and the Department of Health and Social Care (DHSC) set out their 10 year vision to transform the way sepsis is managed. In this blog, I will explore the new Modern Service Framework (MSF) for sepsis and consider whether this marks a genuine turning point in patient safety, or whether there is a risk that sepsis care becomes overly reliant on protocols, screening tools and “tick box” exercises at the expense of clinical judgement and listening to patients.

Sepsis remains a clinical emergency

Sepsis remains one of the most serious and time critical medical emergencies faced by clinicians. It can develop quickly, sometimes from what appears to be a relatively minor infection and it requires prompt recognition, investigation, treatment and escalation. For patients and their families, the consequences of a delayed diagnosis of sepsis, sepsis misdiagnosis or a failure to treat can be devastating. In some cases, the outcome may result in a prolonged admission, septic shock, life-changing injury or an avoidable death.

According to the Sepsis Trust, over 82% of sepsis survivors are experiencing “Post Sepsis Syndrome” in the 12 months following their discharge, with 18% being left permanently unable to work. It is no wonder that the government is seeking to take action, as the condition has recently been estimated by the York Health Economics Consortium to cost the UK economy £23 billion annually.

As clinical negligence practitioners, we often find that the problem is not a failure to consider infection, but a failure to recognise and respond appropriately to the significance of a patient’s clinical deterioration. Missed sepsis symptoms, abnormal observations, concerning blood results, a rising NEWS2 score, or family concerns that “something is not right” can all be warning signs. The difficulty is that sepsis does not always present neatly, consistently or in accordance with the multiple frameworks that exist to assess its likelihood . It is a condition that can arise anywhere: in an emergency department, following surgery, in maternity care, in children, in the elderly, or after contact with a dentist, GP or urgent care service. This clinical complexity is precisely why patient safety depends upon more than simply completing a form or slavishly following a set of guidelines.

In the next part of this series, I will consider the new Modern Service Framework for sepsis in more detail, including what it is intended to achieve and whether national standardisation could make a meaningful difference to patient safety.