Improving multidisciplinary severe sepsis management using the Sepsis Six

Abstract

Each year in the UK, it is estimated that more than 100,000 people are admitted to hospital with sepsis and around 37,000 people will die as a result of the condition. We present an audit, re-audit and the implications these have had on the management of severe sepsis using the Sepsis Six, ultimately through actively promoting teamwork to initiate the protocol. This led to a significant improvement in management, decreasing admissions to the intensive care unit (ITU), length of stay in hospital and the number of patient deaths. The initial audit and re-audit were done over 2-month periods. All clerking notes of patients with a medical consultant diagnosis of 'sepsis' on post-take ward round were analysed and further screened for presence of severe sepsis according to national guidelines. There was significant improvement from only 1% of patients being appropriately managed (according to the existing guidelines) to 67% of eligible subjects adhering to the protocol (p<0.0001). Initially, 19% were admitted to the ITU (6% died), improving to 7% on re-audit (with no deaths). Length of hospital stay reduced from 10 to 7 days (p<0.0001). There was a complete change in the management of severe sepsis with trust-wide updated protocols, resulting in a decrease in hospital morbidity and mortality.