Health Service Focus

24.10.19

Saving lives using technology

Source: NHE: Sep/Oct 19

Afzal Chaudhry, consultant nephrologist and chief clinical information officer at Cambridge University Hospitals NHS FT (CUH), describes how new monitoring technology is allowing patients at risk of sepsis to be identified and treated more quickly.

Sepsis is a life-threatening condition that arises when the body responds to an infection by attacking its own tissues and organs. Every year in the UK, 250,000 people are affected by sepsis and it accounts for approximately 44,000 deaths - more than bowel, breast and prostate cancer combined. However, sepsis can be difficult to spot and is often mistaken, in the early stages, for other more localised infections. National guidance recommends that patients with sepsis are given antibiotics within an hour of diagnosis to reduce the risk of serious complications as for every hour of antibiotic delay, the risk of mortality increases by approximately 8%. 

In 2016, we created a Sepsis Action Group at Cambridge University Hospitals FT – comprising of clinicians from our emergency department, infectious diseases, acute medicine and rapid response teams, as well as our eHospital digital team. They collaboratively explored how technology could be used to better alert clinical colleagues to patients with potential sepsis when they present in our emergency department. They subsequently developed and built an innovative ‘alert and action’ set within our EPR used across both of our hospitals - Addenbrooke’s and The Rosie. 

This ‘alert and action’ set - a form of clinical decision support - was launched in our emergency department in August 2016. The alert brings to the attention of both nurses and doctors that sepsis could be a possible diagnosis if a patient's clinical observations (including temperature, blood pressure, pulse and respiratory rate) meet certain criteria. The ‘action’ feature then provides a series of electronic prompts to support clinicians in undertaking the necessary steps and tests, linked to national guidance, to effectively diagnose, care for, and treat the patient. 

As 99% of all clinical care at our hospitals is documented, ordered and available in our EPR, our nurses electronically order blood samples, blood cultures and oxygen for potential sepsis patients; these are typically completed within 30 minutes of receiving the alert. When a doctor arrives to see the patient, the results are available in the system, enabling the appropriate treatment to be immediately determined. Within the EPR, doctors select the most appropriate antibiotics to treat the source of the patient’s infection, with the system providing additional decision support by recommending the correct dose and frequency. 

Since implementing this digital initiative, we have seen a 70% increase in the proportion of patients with sepsis receiving antibiotics within the recommended one-hour national timeframe when presenting in our emergency department. Following this success, we tailored the ‘alert and action’ set to our inpatient areas and rolled it out across all adult inpatient wards in June 2017 – achieving a 50% increase in patients receiving antibiotics within one hour of sepsis diagnosis. 

When compared to our 2015 data, we have successfully reduced sepsis mortality by between 28% and 42% across our two hospitals. In 2018/19, this equated to at least 64 lives being saved. This significant improvement in sepsis care is an excellent example of how we as a trust are combining clinical and technical expertise and using our advanced technology and capability in healthcare to benefit our patients and improve outcomes. 

And as a Global Digital Exemplar, and a leading digital Trust in the UK, we have recently created a national blueprint of our sepsis work with NHS England to help support other NHS trusts in their use of technology to improve patient safety and sepsis treatment on a national scale.

FOR MORE INFORMATION

Tw: @AfzalChaud

W: www.cuh.nhs.uk

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