Plans to trial sepsis target could be dropped

Multiple sources told HSJ the suggested target could instead be subsumed into a broader “physiological derangement” metric measuring performance on how quickly the most critically ill patients are treated.

The news follows NHS England’s clinical standards review, published in March, which proposed trialing new one-hour targets for a range of “life threatening conditions”, including sepsis, heart attacks and strokes.

The proposals were part of plans to reform urgent and emergency care targets, which could pave the way for the abolition of the four-hour target.

NHSE told HSJ “discussions were ongoing” and that ”sepsis remains a clinical priority and has not been dropped”. 

But sources familiar with discussions around the trial confirmed that, while sepsis remained a clinical priority, it could be subsumed into a wider target around “physiological derangement” rather than being one of a handful of conditions with standalone targets, like strokes and heart attacks.

HSJ understands the broader metric would be based on patients’ national early warning score, known as the NEWS 2, which aggregates a series of vital signs, such as blood pressure, heart rate, oxygen saturations and consciousness.

The move follows concerns raised by senior emergency and acute clinicians that a sepsis target could encourage “bad clinical practice to beat the clock”, as reported by HSJ in March.

Several senior clinicians told HSJ subsuming sepsis into the broader metric “made clinical sense”.

The trial of new urgent and emergency care standards as set out in NHSE’s clinical standards review is now at the halfway stage.

The 14 pilot trusts (listed below) have completed their first six-week test of new urgent and emergency care metrics, including average time spent by patients in accident and emergency.

The second phase of the trial, set to begin in the coming weeks, will also look at new rapid response one-hour targets, or potentially shorter in some cases for a range of “life threatening” conditions.

HSJ understands conditions being considered are heart attacks, strokes, major trauma, physiological derangement and severe asthma. The list of conditions remains subject to significant debate and further changes have not been ruled out.

One senior source familiar with discussions told HSJ “feedback sessions with NHSE have been proving constructive”.

But the source added: “It’s still not clear what people are trying to achieve from the trial.

“They want to reduce target-associated flow, the flurry of activity in the last 15 minutes [which is a good thing], but the outcome metrics of the study are being generated as the study is done. It needed – and still needs – more detailed planning.”

In a statement issued to HSJ, NHSE medical director Stephen Powis said: “Thanks to the hard work of local teams all trial providers have successfully implemented changes to reporting and are approaching the end of the first phase of testing.

“Discussions with clinical experts, stakeholders and field-test clinicians are ongoing to ensure that the first-hour measures which will be trialled in the second phase are based on best clinical practice.”

The 14 trusts field testing the new A&E metrics