Quality Assurance in Severe Sepsis: Audit, Feedback, Improve

Rapid treatment of Severe Sepsis can save lives but requires a coordinated response. Trust-wide audit at Nottingham University Hospitals* in 2006 and 2009 showed significant care deficiencies when compared with international guidelines. Whilst system improvements were tackled with improved infrastructure, antibiotic logistics, and staff education, sepsis care remained reliant on individual clinician response. To make sepsis ‘personal’ we created a rapid audit-feedback mechanism. Every patient audited generated an email report to the treating clinical team. Our rolling Trust-wide audit programme has now provided individualised feedback on over 400 cases since November 2011. Antibiotic administration in <1hour has risen from 40% to over 80% and ‘preICU’ bundle compliance has risen from 25% to 70% across the Trust, with evidence of consistent and sustained response. Outcomes have improved, with crude critical-care sepsis mortality falling from 42% to 28% and our septicaemia SMR has dropped from 119 to 86 since 2009. By defining clear goals and expectations, our audit concept has changed from statistic gathering to promoting personal accountability. The NUH Sepsis programme has been innovative, data-driven and clinically led. We are keen to share our experience so that others can improve performance in this wide reaching but previously neglected disease process.