- NICE says patients with suspected sepsis whose condition deteriorates should be seen “promptly” by consultant
- President of the Society for Acute Medicine says consultant shortages hamper delivery of the standard
- Mother whose son died from sepsis in 2014 says NICE standards will help sepsis to be prioritised
The National Institute for Health and Care Excellence has clarified its latest advice on sepsis after warnings that a shortage of consultants makes the standards “unachievable”.
The president of the Society for Acute Medicine questioned the evidence for new quality standards from NICE, which says patients with suspected sepsis should be seen “promptly” by a consultant if their condition deteriorates within an hour of initial treatment.
Nick Scriven said this standard had not been agreed with specialist societies, which were not involved in discussions about what it said, and clinicians feared they would be expected to attend within an hour.
He said a shortage of consultants in hospitals across England meant meeting the new standard was “currently unachievable” if NICE expected consultants to see patients within an hour.
NICE said its new quality standard should not be read as a consultant needing to be available within the hour but that they should be available soon after concerns are escalated.
Dr Scriven said: “In the current climate of unfilled consultant jobs in front door specialties – up to 40 per cent of consultant appointments were unfilled in 2016 – and financial constraints, this is not a practical solution and is currently unachievable.”
Sepsis kills an estimated 37,000 people a year in England. It is triggered by an infection and leads to an overreaction by the body’s immune system causing organ failure and death.
Dr Scriven said: “Clearly anything that is designed to help the early recognition and treatment of this condition is a step in the right direction [but] it could lead to delays in transfer from emergency departments or have major implications on an already stretched and strained senior medical workforce.”
He said he had “significant concerns” about why the standard in NICE’s quality statement on escalation of care, was not contained in the initial standards shared with specialist societies for discussion, or mentioned in NICE’s publicly available minutes.
“We have submitted our concerns to NICE to ask how inclusion of this standard occurred, the evidence used to recommend it and how NICE believes it could be implemented safely,” he added.
NICE deputy chief executive Gillian Leng said: “Our quality standard on sepsis draws on recommendations from the NICE guideline. It says that a consultant needs to be alerted if someone fails to respond to initial treatment. The guideline went out for public consultation and our quality standard reflects the recommendations it made.
“We recognise that some of these statements may be challenging, but our advice sets out what sepsis care should look like to help save lives that would otherwise be lost.”
Melissa Mead, whose son William died from sepsis in 2014 after errors by GPs and NHS 111 staff, said the NICE standard was a step forward.
She said the standards were important to raise the profile of sepsis, adding: “Clinicians don’t come to work to do harm or act in a malicious way. They want to make people better.
“There are workforce shortages and they are under strain but that doesn’t mean they shouldn’t follow guidelines or standards. We are still in a position where sepsis isn’t prioritised and this standard from NICE should help people to take it more seriously and appreciate the gravity of the situation. It needs to be taken as seriously as a heart attack or a trauma.”