Minister for Health Leo Varadkar today, Thursday 2nd July 2015, addressed 180 delegates at the first National Sepsis Summit held in Dublin Castle. The delegates included hospital CEOs, consultants and senior nursing staff. Sepsis is the 10th leading cause of death worldwide, more than bowel cancer, breast cancer, road traffic accidents and HIV/AIDS combined.
In November Minister Varadkar endorsed a National Clinical Effectiveness Guideline to tackle sepsis for all patients, both adults and children, in emergency departments and in hospital wards. This guideline, which was recommended by HIQA following the tragic death of Ms Savita Halappanavar, was subsequently given an international seal of approval by the UK’s National Institute for Health and Care Excellence (NICE). Today’s Summit aims to raise sepsis awareness and promote full implementation of the guideline.
Minister Varadkar said: “The goal of this summit is to make sure that the new Sepsis Guideline is to put into practice in order to save lives. That’s why we have invited people from across the health service. Sepsis needs to be recognised and treated at the earliest possible stage. The guideline is an important tool for clinicians in recognising sepsis at an early stage, and providing appropriate and timely treatment. In many cases a timely intervention can mean the difference between life and death. I am pleased that the guideline is already being implemented, and that new HIPE coding introduced in January allows us to monitor rates of sepsis cases.”
Tony O’Brien Director General of the Health Service, HSE called for full guideline implementation. “I, along with colleagues from the National Sepsis Workstream, the National Sepsis Steering Committee, NCEC and the Department call on each of us present today, as managers and leaders of our health services, to support the implementation of the Sepsis Management Guideline. The HSE is committed to safe quality care underpinned by clinical effectiveness. In the 2015 National Service Plan, we, the HSE, committed to a number of clinical effectiveness priorities. One of these is the full implementation of the National Clinical Guideline – Sepsis Management across our acute hospitals”, said Mr O’Brien.
The National Clinical Effectiveness Guideline No 6 – Sepsis Management Guideline, promotes safety and higher standards in emergency departments and hospital wards. It was commissioned by the NCEC in partnership with the HSE Clinical Programmes, expert clinicians, regulatory bodies, postgraduate training bodies, private hospitals and patients. Minister Varadkar acknowledged the significant work of Dr Fidelma Fitzpatrick for Chairing the Sepsis Steering Committee, and the work of the National Sepsis Team within the HSE Clinical Programmes, led by Dr Vida Hamilton, in ‘in leading the guideline development group and progressing its timely implementation. He also acknowledged the work of NCEC in advancing patient safety and quality, and the Irish clinical effectiveness agenda, under the chairmanship of Professor Hilary Humphreys.
Guidelines are statements based on best available research and are developed using an internationally recognised process. They outline the most appropriate approaches for clinical practice and are used in conjunction with clinical judgement and patient preference when making decisions about what is appropriate for each patient or population of patients.
The sepsis guideline forms part of a suite of National Clinical Guidelines published by the Department of Health which are uniquely mandated for implementation across the entire Irish health service.
The National Clinical Effectiveness Committee
1. The National Clinical Effectiveness Committee (NCEC) was established as part of the Patient Safety First Initiative in September 2010. The NCECs mission is to provide a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care.
2. The NCEC has a remit to establish and implement processes for the prioritisation and quality assurance of clinical guidelines and clinical audit so as to recommend them to the Minister for Health to become part of a suite of National Clinical Guidelines and National Clinical Audit.
3. The NCEC, chaired by Professor Hilary Humphreys, is made up of key stakeholders including clinicians, patient representatives, the Department of Health, patient safety experts, health managers, regulatory bodies, training and education bodies, insurance and clinical indemnity agencies and private healthcare.
4. The NCEC through the processes of prioritisation and quality assurance of a clinical guideline reach consensus as to whether the clinical guideline has been developed using a quality methodology, is based on evidence and is important for the Irish Healthcare service. Clinical guidelines that meet these criteria are then recommended to the Minister for Health through the CMO for endorsement.
National Clinical Guideline – Sepsis Management
10. The terms sepsis, severe sepsis and septic shock are used to describe the systemic inflammatory response of patients to infection, as a continuum of progressive and life threatening severity. Sepsis is the clinical syndrome defined by the presence of both infection and a systemic inflammatory response.
– Sepsis is the 10th leading cause of death worldwide and the leading cause of death in non-coronary intensive care units.
– International consensus shows that there are approximately 300 cases per 100,000 population per annum. This compares with 208 cases of myocardial infarction per 100,000 per year and 223 cases of stroke.
– European studies estimate that a typical episode of severe sepsis will cost a healthcare institution around €25,000.
12. In Ireland (Source HIPE):
– In 2013, approximately 60% of hospital mortality had a diagnosis of sepsis or infection. 16% of all hospital deaths had a specific sepsis ICD-10-AM diagnosis code, although sepsis may not necessarily have been the underlying cause of death.
– The total number of in-patients with a diagnosis of sepsis is estimated to be 8,831 accounting for 221,342 bed days in 2013.
– In 2013, the mortality rate of patients with a diagnosis of sepsis who were admitted to an intensive care environment was 28.8%.
– Length of stay is shown to be significantly increased with a sepsis diagnosis. While the average length of stay (ALOS) in 2013 for an in-patient is approximately 5.59 days, an in-patient with a sepsis diagnosis has an ALOS of up to 26 days, which is 5 times longer than the average, non-sepsis in-patient stay.
Further NCEC information: www.health.gov.ie/patient-safety/ncec
National Institute for Health and Care Excellence (NICE) Accreditation
13. NICE has accredited NCEC National Clinical Guideline No 6 – Sepsis Management.
14. Accreditation consists of assessing the processes used to develop individual guidelines that are of key importance to the evidence base of UK quality standards in development.
15. With NICE’s accreditation the NCEC National Clinical Guideline No 6 – Sepsis Management will now be presented on the NICE Evidence Services Portal and therefore, viewed in the UK and internationally as guidance of high quality.
16. The NCEC can now publicly display a seal of approval called an Accreditation Mark on the Sepsis Management Guideline for 5 years.
Further NICE Accreditation information: http://www.nice.org.uk/about/what-we-do/accreditation