Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards
Authors: Kopczynska Maja , Unwin Harry , Pugh Richard J. , Sharif Ben , Chandy Thomas , Davies Daniel J. , Shield Matthew E. , Purchase David E. , Tilley Samuel C. , Poacher Arwel , Oliva Lewis , Willis Sam , Ray Isabelle E. , Hui John Ng C. , Payne Bethany C. , Wardle Eilis F. , Andrew Fiona , Chan Hei Man Priscilla , Barrington Jack , Hale Jay , Hawkins Joanna , Nicholas Jess K. , Wirt Lara E. , Thomas Lowri H. , Walker Megan , Pan Myat P. , Ray Tallulah , Asim Umair H. , Maidman Victoria , Atiyah Zeid , Nasser Zain M. , Tan Zhao Xuan , Tan Laura J. P. , Szakmany Tamas ,   The Welsh Digital Data Collection Platform collaborators, Hobrok Maria , Thomas Moriah , Burden Annie , Youssef Nadia , Carnegie Katherine , Colling-Sylvester Helena , Logier Natasha , Alsaeed Meshari , Williams Hannah , Ayob Arfa , Farzana Nor , Parida Sweta , Lawson David , Evans Emily , Davis Laura Jane , Atkins Billie , Davies Llywela Wyn , Sanders-Crook Lee , Seal Steffan Treharne , Cains Alice , Crisp Katy , Venning Sarah , Sykes Ella , Narine Stephanie , Parry Georgia , Dillon Emily Angela , Siah Qi Zhuang , Yang Ting , Jones Tyler , Thara Parvathi , Wood Emma , Pier Georgina St , Betts Richard , Mitsaki Kyriaki , Pierce Mari Tachweed , Davies Sioned , Hafouda Yakeen , Ifan Erin , Lacey Grace , Mitchell Francesca , Lynch John , Mazur Michal , D’Souza Lezia , Ponting Bethan , Lau Terrance , Kerrigan Ruairidh , Morgan Lucy , Vindla Roshan , Zeicu Claudia , James Becky , Ariff Amirah Amin , Azzlan Wan Binti Wan , Collins Charlotte , Wickens Elizabeth , Norbee Alisa , Zulkefli Aliya , Haddock Thomas , Thomas Megan , Lee Matthew , Cynan Miriam , Azis Nik-Syakirah Nik , Hay Imogen , Russell Catherine , Vreugdenhil Margriet , Abdimalik Mustafa , Davies Joseph , Havalda Peter , Evans Angharad , Robertson Kate , Gitau Grace , Gruber Mei-yin , Telford Thomas , Qarout Anas , Nandra Naomi , Garrard Hannah , Cutler James , Jones Rhiannon Tammy , Prideaux Amy , Spence Timothy , Hardie Sarah , Seymour Harriet , Warlow Matthew , Thanthilla Shanali , Downs Thomas , Foley Nina , McKeown Chad , Dandawate Akshita , Shayan-Arani Holleh , Taylor Ellie , Kyriakides Oliver , Price Rachel , Mackey Ffion Haf , Haines Emily , Chun Samuel , Vignarajah Nilarnti , Chamberlain Tessa , Zhao Dongying , Tantirige Nayanatara Nadeesha T. , Dennehey Naomi , Evans Georgina , Watts John , Battle Ceri , Jones Ryan , Jones Selina , James Charlotte , O’Hanlon James , Bridges Isabella , Hughes Bethany , Polchar Leo , Bisson Elise , Mykura Charlotte , Money Lara , McKenna Joshua , Kinsman Sarah , Hanna Demiana , Baker Emily , Sprague Harrison , Sharma Liam , Pontin Tom , Shore Emma , Hughes Tamara , Nightingale Sam , Baby Philby , Shield Matthew , Cross Alice , Boss Jenna , Ross Olivia , Ashton George , Pandit Kimaya , Davies Daniel , Garbutt Cameron , Johnston Charlotte , Cox Marcus , Roberts Chantal , Waller Alessia , Heekin Laura , Wang Kathy , Church Rhianna , Patel Shrina , Broderick Marianne , Whillis Hannah , Hathaway Daniel Craig , Yildirim Emel , Atkins Caitlin , Walters Elin , Durie Carys , Sinnerton Robert James Hamilton , Tanner Benjamin , Abreu Julimar , Bashir Kiran , Hamlyn Vincent , Tee Amelia , Hinchcliffe Zoe Ann , Otto Rita , Covell Georgie , Stone Megan , Godfray Katherine , Caradine Rhidian , Beetham Hannah , Anomneze-Collins Adanna Nicole , Tan Jeanette , Abdelrazik Yasmina , Khan Azizah , Malik Nabihah , Clack Aidan , Thomas Tyler , Mounce Adam George , Ramjeeawon Anoopama , Mtunzi Ndaba , Soppitt Duncan , Wellington Jack , Ross Robert Buchanan , Lis Danielle , Parsonson Rebecca , Joseph-Gubral Jude , Arunthavarajah Ajitha , Harris Aaron , Atkinson Henry , Webster Jessica , Burnett Tim , Gowar Josephine Raffan , DeFriend Sam , Whitaker Jasmine , Beasant Elizabeth , Macchiavello Luis , Usman Danyal , Mahdi Abdullah , Shan Tiffany Ye Tze , Savill Nick , Gee Jennifer , Hodges Lizzie , Desai Ami , Rossiter Hannah , Taylor Matthew , Pinto Kevin , Hartley Eleanor , Emanuel Oscar , Long Rhiannon , Selby Megan , Urquhart Alexandra , Ashman Matthew , Adcock Elizabeth , Dickinson Amelia , Jordache Rebecca , Alaoui Rym Chafai El , Stovold Sophie , Vickery Sam , Jones Nia , O’Donnell Alice , Cuthbert Monty , Eghosa Osa , Karim Muhammad , Williams Lowri , Tucker Louise , Downs Tom , Walford Rebecca , Hook Annabelle , Mounce Adam , Eccles Emily , Edwards Ross , Ramesh Kirtika , Hall Charlie , Lazarou Maria , Jones Rhidian , McGillian Katy , Bhachoo Hari Singh , Teh Zoe , Inpahas Vithusha , Desai Ruchi , Cheema Yusuf , Hughes Andrew , Cranage Olivia , Bee Felicity , Osman Khalid , Khan Humza , Pitt Jennifer , Pickwick Charlotte , Carter Jorge , Andrew Fiona , Seedat Naseera , Patel Roshni , Boam Alicia , Randall Jessica , Bowyer Beth , Edwards Josh , Jones Natasha , Walker Emma , MacNaught Ailsa , Balachandran Swagath , Shipley Abbie , Kent Jennifer Louise , Davies Bethany , Withers Emma , Parmar Krishna , Webber Lucie , Sharma Angelica , Handley Amy , Gordon Alexandra , Allen Lucy , Paddock Rebecca , Penney Harriet , Banerjee Lopa , Vanderpump Chloe Victoria , Harding Kate , Burke John , Minik Orsolya , Jarrett Nia , Rowe Ellie , Anomneze-Collins Adanna , Griffiths Harry , Pengelly Sarah , Bennett Ffion , Bilal Ahmed , El-badawey Abdullah , Ellis Bethan , Cook Luke , Maine Harriet Elizabeth Valentine , Armstrong Kiri , Beresford Hannah , Raven-Gregg Timia , Liddell-Lowe Tom , Ong Caitlin , Reed Harriet , John Frederika Alice St , Kozuch Weronika Julia , Silva Irukshi Anuprabha , Cheng Sin Ting Natalie , Ali Umme-Laila , Syed Noreena , Murphy Luke , Grother Thomas , Smith Harry , Watson Rachel , Marei Omar , Kirby Emma , Gilfedder Anna , Maw Lydia , O’Connor Sarah , Maden Charlotte , Jones Helena , Preston Hazel , Maliki Nur Amirah Binti , Zimmerman Mark , Webber Jessica , Jones Llewelyn , Phillips Rebecca , McCarthy Lauren , Hubbard Emily , Duffy Leo , Sadler Abigail Guerrier , Richards Owen , King Charles , Killick Charlotte , Chema Yusuf , Shergill Kavita , Lau Yi Huen Lillian , Ali Hannah Mustafa , Wilcock Lucas , Timlin Molly , Rela Ayeesha , Smith Daniel , Ireland Sarah , Evans Jennifer , Poobalan Nayanatara , Pearce Jessica , Vadiveloo Thivya V. , Black Zoe , Samuel Daniel Elis , Hussain Humaira , Creamer Rebecca , Zafar Maham , Almazeedi Ahmad , Brunnock Hannah , Jeyanthi Mekha , Moghbel Poorya , Kwan Katie , Sutherland Isobel , Davis Frank , Rogers Abigail , Chantrill Clare , Robertson Amal , Foulkes Jonathan , Khanam Rahana , John Jomcy , Meehan Sarah Hannah , Metezai Huria , Dawson Hannah , Vadivale Navrhinaa , Lee Camilla , Dhadda Amrit , Cleaver Sian , Logue Genna , Inns Joy , Jones Isabel , Howcroft Robyn , Gilbert Carys , Bradley Matthew , Pike Louise , Keeling Rachel , Banks Charldré , Cochrane Eleanor , McFadyen James , Mo Matthew , Ireland Emily , Brittain Esme , Laid Ihssen , Green Charlotte , Mcforrester Adriel , Ly Tu Xuong Michelle , Nalbanti Mariana , Joseph Raven , Tagg Jack , Niina Ayako , Jones Tyler Joshua , Hoyle Natalie , Benc Patrick , Davies Ellen , Wu Meng-Chieh , Fellows David , Baxendale Eloise , Khan Karishma , Forrester Andrew , Moore Oliver , Lim Hse Juinn , Owen Aimee , Hussain Faris , Allybocus Nima-banu , Sethi Maneha , Waring Harry , Khan Adeel , Smith Claire , Doyle Nicholas , Amjad Mohammad Yahya , Galloway Luke , Morgan Paul , Ellis Gemma , Lundin Robert , Al Hassan Haamed , Markall Bethan , Kaur Namratha , Onyango Emmanuel , Beard Heather , Field Elliot , Nelson-Rowe Ellen , Adcock Lizzie , Stoddart Amelia , John Frederika St , Sivananthan Mathoorika , Jones Rhys , Kwak Sung Yeon , Farakish Lily , Rhys-Ellis Holly , Moss Kate , David Tessa , Roberts Talea , Quy Annie , Paranjape Aniket , Bee Felicity , Poolworaluk Nutchanun , Keast Mary , Yao Si Liang , Manning Dion , Irwin Isobel , Boggon Emelia , Alkurd Ibrahim , Lawerece Genevieve , Brown Jade , Murphy Emily , Lambert Evie , Guilford Jeremy , Almulaifi Mariam , Ganesananthan Sashiananthan , Cunningham-Walker Berenice , Spooner Chloe , Kiran Akanksha , Nadeem Nabeegh , Unadkat Vidhi , Sparey Esme , Li David , Smith Jessica , Corrin India , Kurani Amit , McNulty Paul , Brown Ceri , Groblewski Wojciech , Szoke Szilvia , Redman Amelia , McKeag Esther , Donnir Anastasia , Ravishangar Gaautham , Howard Emanuela , Salmon Charlotte , Tanatova Sara , Kew Jasmine , Clark Megan Eilis , Hannay Ellen , Godsafe Olesya , Houghton Christina , Lavric Francesca , Mallinson Rachel , Littler Chris , Reddy Harsha , Campbell Andrew , Soo Benedict , Evans Rachel , Donowho Georgina , Cawthra Alexandra , Davies Maddison , Ashman Matthew Lawrence , Scriven Jamie , Vautrey James , Seet Shannon , Britton Imogen , Hodgson Abigail , Twohey Emma , Robbins Joseph , Ling Vanessa Yeo Yung , Asjadi Kimiya , Shean Carven Chin Yee , McCarroll Zoe , Amatotsero Oritseweyimi , Ashaye Antonia , Acheampong Josephine , Adeleye Ayowade , Ahmed Saber , Chrysostomou Alexandra , Ang Eshen , McSwiney Niamh , Lim Yin Yin , Lee Zong Xuan , Kulikouskaya Svetlana , Zulkifili Nur , Lim Sheryl , Xin Lim , Urazbayeva Adiya , Hanif Nur Haslina Ahmad , Ying Yau Ke , Coleclough Alice , Higgins Eilis , Spencer Naomi , Ng Tze Gee , Booth Sam , Ng Stephanie Wai Yee , Subbe Christian P. , Patterson Isabella , Chia Wen Li , Mukit Abdullah , Pak Hei Yi Vivian , Lock Felicity , Nalmpanti Mariana , Thomas Shôn Alun , Burgher Tanisha , Yeo Alfred Wei Zhen , Jones Siwan Powell , Miles Charlie , Perry Millicent , Burton Holly , Powell Katharine , Nessa Luthfun , Fadlalla Aalaa , Morgan Rhian , Hodges Elizabeth , Heal Amelia , Scott Chloe , Tayler Alice , Taufik Abduahad , Cochrane James , Heng Sieh Yen , Cooper Alex , von der Pahlen Henrik Graf , Talbot Isabella , Roberts Robin Gwyn , Smith Jessica Sharma , Sweeney Aisling , Roberts Cerian , Bausor Laura , Lambirnudi Chania , Thomas Daniah , Puw Elen Wyn , Lyons Ronan A. , Hall Judith E. 
Published: August 2021

The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice.

Trial registration Defining Sepsis on the Wards ISRCTN 86502304 https://doi.org/10.1186/ISRCTN86502304 prospectively registered 09/05/2016.