Because the ICD10 coding for sepsis is known to be inaccurate- if we relied on the coding / central records to identify patients retrospectively for the study, we would miss many patients and include many that would not have sepsis; we would also have a large number of patients who may be less amenable to intervention. The expert group steering the study discussed all the possible ways of identifying patients for the study and prospective identification of patients in critical care plus those seen by outreach was felt to be the most useful.
Why are you only including patients seen by outreach/ critical care- won’t you miss the most important group that are never seen by outreach/ never make it to critical care?
It is true that we could miss a small but important group of patients who die before they make it to critical care/seen by outreach. We are choosing critical care admission/seen by outreach team as a endpoint to pick patients up and we consider that many of the issues affecting these patients are likely to be the same issues as those affecting patients that are not included in the study for the reasons stated above. However, concern that we may be missing out on this group of patients who may have more issues in their pre-hospital care prompted us to propose a sub-study that will focus in this group. This sub-study (currently being worked up) will seek to identify all patients that arrive at the emergency department and have a positive blood culture for one of 3 pathogens. We will then trace back the care in the ED and prior to arrival in hospital for these patients to see if there were remediable factors in their care.
I would like to be a study contact- how can I get involved?
Send an email to sepsis@ncepod.org.uk and we can check if someone isn’t already set up at your Trust and inform your Local NCEPOD Reporter.
When will the final report be published?
The report is due for publication in Autumn 2015.
What is the definition of sepsis being used for this study?
We are asking our Study Contacts to identify patients admitted to critical care or seen by the outreach team with sepsis. It doesn’t have to be the primary diagnosis. For the purposes of the study, sepsis will be defined according to the surviving sepsis campaign as suspected/documented infection plus >1 of listed variables (SIRS criteria). The definition is wide/ inclusive as we are filtering the patients that are sick enough to have been seen by outreach/ admitted to critical care.
Are you looking at sepsis, severe sepsis or septic shock?
We are looking at patients with sepsis- that is the definition we are using as opposed to severe sepsis or septic shock, however, as we are filtering patients that have been seen by outreach/ admitted to critical care, our sample is likely to include a large proportion of patients with severe sepsis/ septic shock.
Would you include patients with sepsis if it is not their primary diagnosis?<
We would include patients with sepsis (seen by outreach or admitted to ICU during the timeframe 6-20 May inclusive) even if sepsis is not the primary reason for their admission (e.g. develops as complication of another condition).
Would you include patients on the ward with sepsis if they are not seen by the critical care outreach team during the timeframe?
Patients that have sepsis but are managed completely on the ward and not seen by the outreach team or admitted to critical care during the time frame should NOT be included.
Would you include patients already on critical care that develop sepsis?
Patients that develop sepsis 48 hours after admission to ICU?HDU would not be included- only new admissions to critical care.
On my copy of the questionnaire, on page 10 it says, “this is a draft form”, is it okay to complete this?
Yes, we are aware that some copies of the form say this on page 10; please ignore an complete this as normal, it won’t affect our reading the data.
I have received a questionnaire to complete but I have looked through the case notes and this patient did not have sepsis at any time during their admission.
Please telephone NCEPOD on 0207 251 9060 to discuss the case. If having looked at the complete case note record (not just the discharge summary), it is certain that the patient did not have sepsis, we would consider excluding the case.
I am going to struggle to complete the questionnaire by the deadline date noted on the cover letter.
Please telephone NCEPOD on 0207 251 9060 to discuss extending the deadline given.
