A clinical review of the indications for, and subsequent implementation of, a pilot pre-hospital sepsis pathway within NWAS

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.