Uniform standards may help improve early recognition of a condition that kills more than 8,700 Australians each year.
The Australian Commission on Safety and Quality in Health Care has launched a national sepsis clinical care standard designed to ensure more healthcare professionals, including GPs, recognise sepsis as a medical emergency.
“While some state and territory health departments have well-developed sepsis pathways, others do not as yet,” the guidance says. “In addition, private hospital, ambulance, pre-hospital and retrieval services, and primary and community healthcare services may not be represented in the existing state and territory sepsis clinical pathways.”
Dr Carolyn Hullick, a NSW emergency physician and the commission’s clinical director, said the new standard would require healthcare services to create systems that flag people who may have sepsis, assess them urgently and, if necessary, refer them to a higher level of care.
The standard is particularly important for country doctors, Dr Hullick told TMR.
“GPs have got a really important role in recognising infection and in sending people to hospital or calling triple zero if they’re in a metro area,” she said.
“While the sepsis clinical care standard covers hospitals, from rural and remote to big metro hospitals, there’s a lot of rural and remote GPs out there delivering hospital care.”
The new guidance comprises seven “quality statements” designed to support the way sepsis is recognised and care provided. They include assessment and early diagnosis; the need for urgent treatment; management of antimicrobial therapy; and multidisciplinary care in hospital. They also outline standards for patient and carer information; a clinical handover where there is a transition in care; and post-hospital care.
The standard recognises that GPs are likely to be involved once a sepsis patient leaves hospital, and notes the ongoing effects of sepsis and “post-sepsis syndrome”. The resources that accompany the guidance include a template discharge letter that a hospital care provider can fill in for the GP.
Dr Hullick highlighted three red flags for sepsis.
“The person often says, it’s the worst I’ve ever felt – so you know they’re really sick,” Dr Hullick said. “Second is that their family is really concerned about them, and third is they’re deteriorating really rapidly – maybe they’ve come back a couple of times with a urinary infection, but this time they’ve got a really high fever and heart rate and low blood pressure.”
It was also important to recognise patients who are at high risk. In Australia, sepsis disproportionately affects the very young, the very old and other high-risk groups, including Aboriginal and Torres Strait Islander people, patients with cancer and people who are immunocompromised.
In the Top End of the Northern Territory in 2007-08, the age-adjusted incidence of sepsis was 40.8 hospital admissions per 1,000 Aboriginal and Torres Strait Islander people compared with 11.8 per 1,000 people in the non-Indigenous population, according to the commission.
Globally, more than half of sepsis cases are in children and adolescents.
Professor Simon Finfer, a professorial fellow at The George Institute – which along with the commission developed the standard – called it a “game-changer”.
“Up to 50% of people who suffer sepsis and survive have ongoing medical problems which affect their physical, psychological and cognitive wellbeing,” he said. “Unlike other conditions, such as heart attack and stroke, there is no coordinated care or rehabilitation for sepsis survivors. The standard is a huge step forward.”
Australia is one of the first countries to release a nationally agreed quality framework for the recognition and management of sepsis, the commission said.
Each year in Australia, sepsis results in $700 million in direct hospital costs and more than $4 billion in indirect costs.