By introducing simple tools and training ward nurses to use them, a Norwegian hospital cut deaths from sepsis - a condition where infection spreads to the bloodstream - by 40 percent.
In the journal Critical Care, researchers describe how Levanger Hospital in Nord-Trøndelag, Norway, reduced deaths from sepsis from 12.5 to 7.1 percent after implementing some relatively simple steps, such as increased ward nurse training and a special observation chart.
The initiative was part of a Norwegian research project that included members from the Mid-Norway Centre for Sepsis Research at the Norwegian University of Science and Technology (NTNU).
Erik Solligård, head of the sepsis research center and an associate professor at NTNU, is senior author of the paper. He remarks:
"Sepsis is a very common and serious condition that many people die from. Patients with lifestyle diseases such as diabetes or cancer are particularly at risk. However, sepsis doesn't attract nearly as much attention."
Sepsis develops when the body has an overwhelming and life-threatening response to infection. It can arise at any age and affects millions of people worldwide every year.
Rates of sepsis likely to rise
Prof. Solligård says rates of sepsis are likely to climb further due the rise in lifestyle diseases and the growing problem of antibiotic resistance.
- In the U.S., sepsis starts outside the hospital for nearly 80 percent of patients
Seven out of 10U.S. patients with sepsis had chronic diseases requiring medical care or had recently used services
- Infections of the lung, urinary tract, skin, and gut are most often associated with sepsis.
Sepsis can cause tissue damage, organ failure, and death. It can develop very quickly and be confused with other conditions in the early stages, making it difficult to diagnose.
However, when it does occur, time is of the essence - sepsis is a medical emergency - prompt diagnosis and treatment saves lives.
The signs and symptoms of sepsis include: shivering, fever, or feeling very cold; clammy sweaty skin; extreme pain or discomfort; shortness of breath; confusion or disorientation; and high heart rate.
According to the Global Sepsis Alliance, sepsis is the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care.
The researchers note that the mortality rate for sepsis in North America and parts of Europe is over 10 percent, and that the risk of death rises for every hour the patient does not receive treatment in the form of antibiotics and fluids.
'Nurses at the forefront of sepsis diagnosis'
For their study, the team devised a flowchart to help Levanger Hospital ward staff identify sepsis and an observation chart for scoring severity for ward nurses to use during triage.
Ward doctors were also given reading materials, and nurses and student nurses attended a 4-hour training session.
In addition, the treatment course for sepsis was standardized accompanied by clear guidelines for doctors and nurses.
The researchers compared results for a group of patients whose stay in the hospital preceded implementation of the new steps and another group treated after implementation.
The results showed that as well as increasing odds of survival (measured for 30 days), the new steps reduced probability of developing severe organ failure, and, on average, cut time spent in intensive care by 3.7 days.
The researchers also noted other differences, such as "the nurses in the post-intervention group increased their observation frequency of all vital signs."
In their paper, they credit the results to a sepsis-specific triage, flowchart alert, treatment system for inpatients, and giving ward nurses responsibility "for being in the forefront of sepsis diagnosis."
"This study suggests that ward nurses have a key function in increasing the survival for patients with serious infection. The use of cost-effective and clear tools for the identification of sepsis and the scoring of severity in patients as well as a standardized treatment course can achieve this."
Prof. Erik Solligård