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A faulty production line

GPs should treat signs of sepsis as urgently as chest pain, advises NICE

NICE experts are advising GPs to treat people who show signs of sepsis in the same way as those suffering with chest pain.

The NICE guidelines, which follow on from draft guidance published in January, outline the systematic processes that need to be in place to quickly identify and diagnose sepsis and so prevent around 44,000 deaths a year.

In the first national evidence-based guideline of its kind, signs and symptoms are presented in tables to help GPs assess each person’s risk based on their age and where they are being treated.

In face-to-face assessments in people with suspected sepsis GPs are advised to ‘assess temperature, heart rate, respiratory rate, blood pressure, level of consciousness and oxygen saturation’.

The guidance stresses that people with sepsis may have ‘non-specific, non-localised presentation, for example feeling very unwell, and may not have a high temperature’.

A spokesperson for NICE told Pulse that a number of changes were made following publication of the draft guidelines. ‘The main feedback we got at consultation was that we needed to ensure there was a good balance between ensuring that cases of sepsis are identified promptly without over diagnosing and burdening the service with people who don’t have sepsis.’

Another change was clarifying the ‘think sepsis’ message, as the majority of people with infection do not have and will not get sepsis and do not need detailed assessment, added the spokesperson.

According to the UK Sepsis Trust there are around 150,000 cases of sepsis in the UK each year which causes around 44,000 deaths. A report by the National Confidential Enquiry into Patient Outcome and Death published last year revealed delays in identifying sepsis in over a third (36%) of cases.

RCGP chair Dr Maureen Baker said: ‘The diagnosis of sepsis is a huge worry for GPs as initial symptoms can be similar to common viral illnesses so we welcome any guidance or support to help us identify it as early as possible.

‘Sepsis is one of the college’s spotlight projects until April 2017, and as part of this programme we will be working with NHS England and Health Education England to help improve the outcomes from sepsis, particularly in collaboration with colleagues across the NHS to reduce deaths from sepsis each year across the UK.’

Professor Saul Faust from the University of Southampton and chair of the group that developed the NICE guideline said: ‘Sepsis can be difficult to diagnose with certainty. We want clinicians to start asking "could this be sepsis?" much earlier on so they can rule it out or get people the treatment they need.

'The thinking should be similar to considering that chest pain could be heart related. Just like most people with chest pain are not having a heart attack, the majority of people with an infection will not have sepsis. But if it isn’t considered then the diagnosis can be missed.’

Professor Mark Baker, director of the NICE Centre for Guidelines said: ‘Once identified, sepsis can be treated very quickly and people are more likely to make a full recovery. If there is any delay in spotting the signs we will fail patients by leaving them with debilitating problems or in the worst cases people will die.

‘This guideline will be the first to provide advice based on the best available evidence on how to quickly identify and treat people with sepsis.’

Professor Frank Joseph, consultant physician and spokesperson for the Royal College of Physicians said: ‘This guidance on sepsis is timely and vital for busy clinicians on the front-line of urgent medical care. It is vital for patient care that doctors are able to initiate crucial early treatment for sepsis in order to save lives and improve patient outcomes.’

Readers' comments (17)

  • Can we please drop this? This guidance was clearly drawn up by someone who doesn't sit at the coalface seeing people with tachycardia and tachypnoea all winter long or regularly deal with the whole spectrum of psychiatric disease from mild delirium to florid psychosis. What has been presented is totally useless to the jobbing GP and just increases our risk of being exploited by venal lawyers and hung out to dry by the GMC. I seriously doubt we can save 1000 extra lives by drowning the population in tazocin let alone 44,000. The people who sit in these ivory towers are in denial that our job is hard and we are looking for needles in haystacks. The NHS is under-resourced and cannot cope. Antibiotic resistance is rising at alarming rates. Please, give us a break!

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  • Why do Royal Colleges consistently support this nonsense? This does nothing but shift a system wide problem (delays in treatment of sepsis) into the personal responsibility of independent clinicians, and all of the medico-legal and media nightmares that follow. From the view of someone currently in secondary care, mortality is high with sepsis a) because of late presentation due to lack of social support for elderly/vulnerable families b) because of long waits in assessment units regardless of triage outcome c) short-staffing resulting in delays in detecting deterioration, delays in investigation and delays in getting antibiotics.

    The language used in this campaign frames sepsis as a discrete disease, and one that can be 'beaten' or 'defeated'. It isn't. People will always die of sepsis, for lots of people, it's the end result of long disease (eg. bronchopneumonia in lung CA). Stop using this language, stop demonising individuals, and start addressing system-wide failures that are a direct result of reduced funding of social care and secondary care staffing.

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  • First you demonize those giving antibiotics and then you say oops that is sepsis.
    A healthy balance in prescribing is well left to doctors without NICE interference or undue pressure or guidance

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  • Vinci Ho

    If you are a layman person, how would you work out this in contrast :
    Lead author Professor Martin Gulliford said: ‘Our results suggest that, if antibiotics are not taken, this should carry no increased risk of more serious complications.

    ‘General practices prescribing fewer antibiotics may have slightly higher rates of pneumonia and peritonsillar abscess but even a substantial reduction in antibiotic prescribing may be associated with only a small increase in the numbers of cases observed. Both these complications can be readily treated once identified.’

    Co-author Dr Mark Ashworth, a GP and researcher at King’s College London, said: ‘Our paper should reassure GPs and patients that rare bacterial complications of respiratory infections are indeed rare.

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  • A Catch 22 moment indeed.

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  • On the other hand this makes our job alot easier.Let's start admitting anyone with fever and then just sit back and watch the NHS collapse.

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  • This is ridiculous. But if they want more admissions in A+E and AMU then they are welcome. We will not be defended by our insurers if we go against this guidance. We are damned if we prescribe antibiotics. I just think the world is going mad... time to emigrate!

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  • Took Early Retirement

    At least Dr Baker points out that the symptoms can be identical to those of flu.

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  • I probably will be admitting one patient / day with sepsis after reading the guidance.

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  • GP Partner13 Jul 2016 6:38pm

    Remember that it may not cause fever so you will have to admit everyone.

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