The challenge of sepsis and recognising acute deterioration

By Clare Dieppe, Clinical Lead, Improvement Cymru.

A few months ago I found myself sitting in the high dependency unit relatives’ room waiting for an update on my partner who had just been admitted from the Emergency Department with sepsis. As a doctor, being a relative waiting for an update was difficult, but perhaps not as difficult as wondering the evening before whether my partner really was that unwell and at what point I needed to escalate – no longer staying at home and following the advice given by the GP but instead taking her to hospital. The good news is that we got the timing right – but as we approached this year’s World Sepsis Day, I was reminded of this event and the challenge not just of sepsis but the step before that – recognising acute deterioration.

Acute deterioration is about recognising the point at which the patient needs a different level of care and escalating to the right person or place to make that happen. In hospitals we monitor observations such as heart rate, respiratory rate, temperature and oxygen levels, so we can keep track of whether patients are improving or getting worse. But we are not always as effective as we should be at recognising or responding to the point at which this changes. Importantly it is not just in hospital that we need to recognise the change, acute deterioration happens across the healthcare system and across all ages. Babies with respiratory illnesses getting worse and needing ventilator support, adults with chronic disease needing a different level of treatment, patients at the end of life needing a shift in the focus of care – in care homes, hospices, GP surgeries and hospitals.

As I sat in the waiting room not knowing how sick my partner was, I wondered whether I should have come in earlier or responded to the increasing heart rate sooner. I realised that my own thinking could have got in the way of me recognising how unwell she was. I thought she didn’t have any underlying reason to be seriously ill and I thought I would feel ‘silly’ if I brought her to hospital unnecessarily. Similar thoughts to these can also happen in the healthcare system – concerns about disturbing seniors; not believing the abnormal observations as the patient has no risk factors for serious illness; relying on our clinical experience more than the findings in front of us. This means that alongside the use of early warning scores and pathology specific scores we need to look at the wider processes, cultures and individual factors that influence the way we respond to acute deterioration in different areas across all aspects of the healthcare system to support and improve.

I was able to push these thoughts aside early enough to escalate appropriately, supported brilliantly by my colleagues once we arrived at the Emergency Department and continued when my partner was moved to High Dependency, but sadly this isn’t always the case. Improving the recognition and response to acute deterioration has a huge part to play in making care safer and better for all patients across the whole healthcare system. Fortunately, acute deterioration is one of the areas that the Safe Care Collaborative is going to focus on, an aspect of our improvement work that I am excited and pleased to be working on as part of my role.

If you would like to learn more about the importance of raising awareness of sepsis and the resources available, listen to our podcast, Talking Improvement with Terence Canning, Welsh Executive Director for UK Sepsis Trust.