Can we improve sepsis care, out there?

Authors: L. Regan¹, J. Schneider², G. Rushworth³, S. Brown³, J. Rennie², E. Tait², L. Cammaert², E. Semple², M. Clarkson², R. Manson², A. Gatenby⁴, S. McWilliam², I. Robinson², H. Al Moosawi³, A. Kamona³, E. Al Lawati³, A. Al Hindi³, R. Al-Manari³, A. Al Khusaibi³, K. Almazroui³, C. Barnetson⁴, J. Wubetu⁴, A. Radwanska⁴, A. Reed²

Background: Sepsis care in hospitals has undergone dramatic review and improvement over the past decade.
Aims: To develop a framework which could implement and test the key features of hospital sepsis care in the pre-hospital environment.
Method: Existing research was reviewed to identify areas of proven patient or process benefit both within and without hospital settings. A modified hospital sepsis treatment pro-forma was tested using a workshop with a large group of remote practice GPs, the purpose of which was to adapt its assessment criteria and interventions to better match the context and facilities of remote and rural practice. Ethical and Caldicott Guardian approval were sought for a trial where the clinicians were the subjects, the pro-forma-directed bundle of care was the intervention, rather than individual elements within it, and the outcomes were patient-centred ones of mortality, length of stay and ITU admission.
Results: The workshop process produced a pro-forma with modified assessment measures, a 'sepsis 3' of titrated O₂ therapy, bolus crystalloid and single dose of IV/IM broad spectrum antibiotic with clear instructions on how to perform these procedures. Signs of organ dysfunction were also adapted to suit clinicians distant to hospital and directions made for expediting transport of those classified as 'severe sepsis'. Approval was granted for the first ever trial of a complete algorithm for pre-hospital treatment of sepsis with antibiotics, fluid and oxygen.
Conclusions: Engagement with remote clinicians and a systems approach to research frameworks and interventions can result in meaningful and clinically relevant sepsis research in remote and rural medicine.

This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.