A clinical review of the indications for, and subsequent implementation of, a pilot pre-hospital sepsis pathway within NWAS
Butterworth, Daniel
Butterworth, Daniel
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Abstract
Abstract published with permission.
Aim: Review the clinical evidence for, and introduce a modified ‘Red Flag’ sepsis
screening tool, treatment pathway and associated education package into a pilot site
within the North West Ambulance Service NHS Trust (NWAS) and evaluate its impact.
Methods: Retrospective application of a modified ‘Red Flag’ sepsis screening tool
to 259 hospital confirmed cases of sepsis to evaluate the current identification and
treatment of sepsis within NWAS.A subsequent prospective pilot launch of the tool
within central Manchester in collaboration with Salford Royal Foundation Trust and
Central Manchester Foundation Trust hospital emergency departments,collecting and
analysing 100 cases of suspected sepsis in which the screening tool has been utilised.
Results: The modified ‘Red Flag’ sepsis tool was found to be highly sensitive when
applied retrospectively. Only 46% of confirmed severe sepsis cases were found to
show hypotension (systolic BP <90 mmHg) pre-hospital. In the pilot,complete analysis
of Systemic Inflammatory Response Syndrome (SIRS) criteria and a suspicion and
documentation of sepsis increased from 15% to 94%. Compliance with a bundle of
care in suspected severe sepsis cases increased from 10% to 90%.
Conclusions: The introduction of a modified ‘Red Flag’ screening tool significantly
improved pre-hospital sepsis identification and treatment within the pilot site.
Paramedics were able to give fluid boluses to normotensive patients in suspected
severe sepsis safely without adverse incident.