Presentation by Dr Emmanuel Nsutebu, Clinical Lead for Sepsis, Royal Liverpool Hospital at ECO 14 in Preston - "Development and use of e-sepsis to improve management of sepsis at the Royal Liverpool Hospital".

1. Development and use of e-sepsis to
improve management of sepsis
Dr Emmanuel Nsutebu
Consultant Infectious Disease Physician &
Clinical lead for sepsis
National Advisor Sepsis (NHS England) and
Deterioration (NHS Improvement)

2. • Patients want us to “make them better, not harm
them, be nice to them, continue to improve”
• “Quality & Patient safety is about culture, systems
and trained staff working in teams”
• “Every system is designed to deliver what it delivers”
• We wanted to reduce variation and shift focus to
inpatients
Background

3. • Used electronic recording of observations and
National Early Warning score (e-NEWS)
• Used blood results e.g. White cell count, lactate
and U & Es
• Algorithm built on published evidence and
national guidance – NHS England sepsis
guidance 2017
How we did it?

4. • IT team and Clinicians met weekly to
develop the system
• Tested and rolled it out with support
• Continued to support and engage staff
• Identify and address culture and system
issues
How we did it?

5. E-Sepsis on ADT
Dashboard

6. Ward view:
Select patient
from Ward View
E-Sepsis on ADT

7. Click
Observations,
Click add new
observations:
E-Sepsis on ADT

8. Work through
each parameter
and record the
results:
E-Sepsis on ADT

9. Review NEWS
score – depending
on results, Step 1
of the Sepsis
evaluation may be
a mandated
question:
Answering Yes opens up Step 2
E-Sepsis on ADT

10. • Step 2 will auto tick
boxes dependant on
observations and ICE
look ups
• If any lines in Step 2 are
ticked, the patient is
placed on the Sepsis
Pathway for treatment.
E-Sepsis on ADT

11. Treat patient in
line with Pathway
and mark tasks as
complete:
E-Sepsis on ADT

12. Complete Pathway:
E-Sepsis on ADT

13. What has been the impact?

14. • Screening
Commissioning for Quality and
Innovation data

15. • Antibiotics <1 hr
Commissioning for Quality and
Innovation data

16. Reduction in mortality
In hospital mortality Mortality
Reduction
Numbers of patients
coded
2016/17 2017/18 2016 2017
Sepsis 19.5% 18% 1.5% 1600 1430
Severe
sepsis
46% 32% 14% 160 94
Septic
shock
55% 43% 11% 56 85

17. Understanding of quality of care on wards

18. • GP referral to cardiology with chest pain
Case Example

19. • Importance of clinicians and non-clinicians working
together to develop systems
• Non-clinicians can improve patient care
• It was adaptive not technical change -uncovered
culture issues and wider system issues about
responding to deteriorating patients
• We developed a safer system, reduced variation
and mortality
• Freed up sepsis nurse time to focus on clinical
work and quality improvement
Learning outcomes

20. Thank you
• Emmanuel.Nsutebu@rlbuht.nhs.uk
• Acknowledgements:
– Sepsis Team – Darren Railton, Jessie Monis, Maz
Hoyle, Victoria Riley
– IT Team – Tony Morley, Gemma Jones, Andrew
Davies