Significant failings in sepsis care

  • Date: 13 September 2013

NOT enough is being done by doctors and other healthcare staff to save the lives of sepsis patients says the Health Service Ombudsman in England.

A new report highlights "significant failings in the diagnosis and treatment of severe sepsis" in ten cases investigated by the Ombudsman where patients died.

Sepsis accounts for 100,000 hospital admissions each year, with an average cost of about £20,000 each, according to the UK Sepsis Trust. Around 37,000 people are estimated to die of sepsis each year. The most common causes of severe sepsis are pneumonia, bowel perforation, urinary infection and severe skin infections.

In its report the Ombudsman found that care failings seem to occur mainly in the first few hours after arriving in hospital, when rapid diagnosis and simple treatment can be critical to the chances of survival.

Among shortcomings noted were a lack of timely history and examination (including adequate nurse triage) on presentation, lack of necessary investigations, failure to recognise severity, inadequate first-line treatment and physiological monitoring of vital signs, and delay in source control of infection. The report also cites delays in senior medical input and a lack of timely referral to critical care.

Recommendations include improving the recognition of sepsis and treatment, along with improvements in auditing and research.

The Health Service Ombudsman, Julie Mellor, said: "In the cases in our report, sadly, all patients died. In some of these cases, with better care and treatment, they may have survived. It is time for the NHS to act to save lives by improving the care of patients with sepsis.

"We have worked closely with NHS England, NICE, UK Sepsis Trust and Royal Colleges to find solutions to the issues identified in our report. NICE and NHS England have already agreed to take forward the recommendations of our report. We know it is not easy to spot the early signs of sepsis, but if we learn from these complaints and work to improve diagnosis and provide rapid treatment, then lives can be saved."


Time to act - Severe sepsis: rapid diagnosis and treatment saves lives

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