Surviving septicaemia: is it a postcode lottery that could impact on sepsis survival?

The results of this report compare the actual number of patients who die following hospitalisation at a particular trust with the number that would be expected to die on the basis of a national average and on the characteristics of the patients treated there. The results are broken down further according to the cause of death and this blog looks particularly at the results relating to deaths caused by septicaemia.

Whilst septicaemia is a separate condition to sepsis, as identified by Meningitis Research, it can often be a precursor to the development of sepsis in patients. Therefore, the management of this blood infection is vitally important in the reduction of deaths from sepsis.

NHS England are keen to stress that when a trust has had a much higher number of deaths than expected, this doesn’t necessarily indicate a poor quality of care. But, let’s be honest, it doesn’t look fantastic for the trust. They also stress that it is not helpful to rank trusts according to their results but doing this highlights how septicaemia-survival differs from trust to trust. After all, the question that we all want to know the answer to is: which trusts had the most excess deaths from septicaemia and which ones had the fewest?

Where in the country are the most people dying from septicaemia?

Having painstakingly transferred the NHS data results into a good old-fashioned Excel spreadsheet, I can confirm that the three trusts that fared the worst are as follows:

• In third place is The Rotherham NHS Foundation Trust. At this trust, 115 people were expected to die from septicaemia (excluding women who developed septicaemia in labour) from April 2018 to March 2019 but, in fact, 155 people died from the condition.
• In second place is University Hospitals of North Midlands NHS Trust, where 260 people were expected to die from septicaemia but 360 deaths were observed.
• And finally, the most dangerous trust to have septicaemia appears to be Tameside & Glossop Integrated Care NHS Foundation Trust. At this trust, only 75 people are expected to die from septicaemia but the trust saw 120 deaths. This represents a 60% increase on what was expected.

Where in the country is the safest place to go to hospital with septicaemia?

So which trusts fared the best? Or to be honest, the question we are actually interested in is: which trusts enjoy better patient safety when it comes the septicaemia?

• In third place is Walsall Healthcare NHS Trust, where 180 people were expected to die from septicaemia but only 125 did.
• In second place is Poole Hospital NHS Foundation Trust. At this trust, 125 people were expected to die but only 80 deaths from septicaemia were observed.
• And in first place, the safest trust to attend with sepsis in the whole of England appears to be The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust. Here, 150 people were expected to die but only 80 deaths were recorded as resulting from septicaemia.

Digital tools to identify sepsis

Some trusts have developed new tools to help identify sepsis and I have already blogged about the new e-sepsis tool used by The Royal Liverpool and Broadgreen University Hospitals NHS Trust to alert hospital staff to the fact that a person might have sepsis. As a result of e-sepsis, the Trust has celebrated seeing people receiving treatment faster and the drop in death rate from sepsis as a result. So I was interested to see how this trust compared to other trusts in terms of the number of deaths from septicaemia.

The Royal Liverpool and Broadgreen University Hospitals NHS Trust recorded 150 observed deaths from septicaemia (excluding women in labour) when only 145 were expected based on the national average and the characteristics of the people they treat. Whilst this is 5 more deaths than expected, it does not represent a statistically relevant increase so I don’t think we need to curtail the trust’s celebrations just yet. However, if we were to rank the trusts, The Royal Liverpool and Broadgreen University Hospitals NHS Trust appear in 78^th position out of the 130 trusts so I think they still have a little way to go.

So what can we take away from these results? I think the most obvious conclusion is that if you have any last-minute end of summer holiday plans, you are safer to take your bucket and spade to the south coast of England, around Poole and Bournemouth in particular, than to take your walking boots to the Peak District, around which the three trusts that fared the worst are situated!

In all seriousness though, sepsis and septicaemia can have devastating consequences. It is crucial that the condition is identified and treated very quickly and my hope is that the trusts that have the largest number of excess deaths from septicaemia will implement new protocols and practices that result in people being treated for sepsis more promptly.