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NHS England admits GP system sepsis alerts were 'over-triggered'

Sepsis alerts currently embedded in GP software are being over-triggered and the software needs to be improved, a senior NHS England official has admitted.

Dr Celia Ingham Clark, medical director for clinical effectiveness at NHS England and interim national patient safety director at NHS Improvements, said that there was a need to update the software - which has embedded NICE guidance and alerts GPs to potential sepsis cases - after many GPs complained of the alerts being 'over-triggered' and switching them off.

GP leaders have warned that GPs are suffering from ‘alert fatigue’ due to the warnings being activated at very low thresholds.

Speaking at the Westminster Health Forum Keynote Seminar on improving sepsis outcomes last week, Dr Clark said that NHS England were talking with GP software providers and that they wanted 'to ensure that the algorithms that the big software providers use are up to date with NICE guidance and also don’t over-trigger, because we know that if they over-trigger, GPs switch them off and they’re no use at all'.

Dr Clark continued: 'To be absolutely honest I’m not up to speed with whether the software providers have changed their algorithms or not.

'When I last interacted with them six months ago, they were saying that they were going to do it and I need to go back to them again. It’s important that what they put on the algorithm fits with the NICE guidance and it’s important that they’re not set at a level that over-triggers, meaning that GPs switch them off.

'It’s a competitive market between the main software providers and it’s an opportunity for any of them to get a market advantage by doing this well and quickly.'

NHS England conceded in September that the 2016 guidance on sepsis, which includes lists of warning signs that should prompt referral, had been tricky to implement, saying that front-line staff had found it ‘difficult to translate this guidance in to practice.’

BMA GP Committee member Dr Andrew Green described the software alerts as 'a lesson in how not to use IT' back in October.

He said: 'The largest problem with it is the low threshold for sending an alert. The result is that these alerts are ignored. Should that "suspected UTI" patient go on to have sepsis, GPs may find themselves having to justify why they did not take action earlier.

'Inquests where people have ignored warnings rarely look at the contribution of alert-fatigue.'

Readers' comments (6)

  • Pop-up fatigue. Does anyone really use it? Or do we use our years or training and experience to figure out if someone is septic rather than rely on the scores of pop-ups we see each time we open a patients notes. Crazy.

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  • Type “no fever” into Systmone at my practice and you get a sepsis alert. Hence no one pays it attention any more. Just like the weekly fax telling me A&E is very busy.

    Wonder what the next IT wheeze will be?

    I’m sick of being treated like a complete moron.

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  • 'It’s a competitive market between the main software providers and it’s an opportunity for any of them to get a market advantage by doing this well and quickly.'
    Does anybody - apart from the upper echelons of NHSE, it seems - believe this market nonsense anymore? The hurdles to switching clinical systems are huge.

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  • Dear Nigel,
    Where has the article on Babylon costing their host CCG £150,000 in 2 months gone?
    Regards
    Paul C

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  • The problem is this malware isn't harmless. For one, it's a massive distraction during consultations. It raises expectations and puts us at medico-legal risk if we don't comply with often nonsensical NICE guidelines. We shouldn't be beta-testing software in a healthcare environment especially as we weren't even asked! True sepsis is rare in the primary care population and cannot be spotted on clinical measurements alone. The sepsis bandwagon was never about safety but making money from yet another health scare.

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  • Heaven help us during "hay fever" season.
    Experience and gut instinct are best at picking up sepsis.
    Some sepsis will always be undetectable in early stages in the best of hands. But the lawyers must have their Audi and school fees paid.

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