Improving the quality of medical and surgical care NCEPOD SEPSIS STUDY

Improving the quality of medical and surgical care 2 NCEPOD To review medical and surgical practice and to make recommendations to improve the quality of the delivery of care. By undertaking confidential surveys covering many different aspects of medical care and making recommendations for clinicians and management to implement.

Improving the quality of medical and surgical care 3 SEPSIS study: Aim “To identify and explore avoidable and remediable factors in the process of care for patients with known and suspected sepsis”

Improving the quality of medical and surgical care SEPSIS study: Objectives To examine organisational structures, processes, protocols and care pathways for sepsis recognition and management in hospitals from admission through to discharge or death To identify avoidable and remediable factors in the management of the care for a sample of adult patients with sepsis, throughout the patient pathway from presentation to primary care (if applicable) throughout secondary care to discharge or death 4

Improving the quality of medical and surgical care Key areas Recognition of sepsis Evaluation of systems in place to facilitate recognition/ escalation/ treatment Management of infection MDT approach Communication End of life care 5

Improving the quality of medical and surgical care 6 Case Identification-prospective Prospective identification Study contacts set up in critical care (ICU/HDU) and on critical care outreach team (CCOT) Study contacts identify cases in ICU/HDU and seen by CCOT during study period: 6 th -20 th May 2014 Study contacts complete case ID spreadsheet and return to NCEPOD

Improving the quality of medical and surgical care Study population Adult patients (≥16 years old) that are seen by the critical care outreach team (or equivalent) or that are admitted directly to critical care with sepsis during the study period: 6 th - 20 th May

Improving the quality of medical and surgical care Exclusions Immunosuppressed neutropaenic patients on chemotherapy, immunosuppressant drugs or transplant programmes. Pregnant women up to 6 weeks post-partum (covered by MBRRACE-UK sepsis study) Patients on end of life care pathway at time of diagnosis or consultant-led decision made not to escalate (prior to entry into the study) Patients that develop sepsis after 48 hours on ICU/HDU Children <16 years 8

Improving the quality of medical and surgical care 9 Data collection- retrospective Retrospective data collected on patients identified –including consultant details, discharge/30 day outcome information and ICD10 coding Clinician questionnaire – completed by named consultant at time of diagnosis - collect data on acute care up to 30 days after entry into the study Case note extracts – admission to discharge/30 days after entry into the study. Organisational questionnaire –collect data on organisation of care –To be sent to all hospitals that deal with adult patients with sepsis

Improving the quality of medical and surgical care 10 Advisor case review Multidisciplinary group of Advisors will be recruited to review case notes and questionnaires and rate the quality of care Advisors will be recruited from a number of specialties including: emergency medicine, acute medicine, critical care outreach, general medicine, general surgery, intensive care.

Improving the quality of medical and surgical care Queries Findings will be published in Autumn 2015 Please visit the NCEPOD website or call for more information Thank you for your support! 11