Meet the team: OPSSI (Oxford Patient Safety Sepsis Initiative)
Associate Director Patient Safety
Wessex Patient Safety Collaborative, Wessex Academic Health Science Network
- England - Wessex
- Jo Murray, Sepsis Patient Safety Manager, Patient Safety Collaborative, Oxford Academic Health Sciences Network (AHSN)
- Dr Andrew Brent, Clinical Lead, Sepsis Stakeholders Group, Oxford AHSN; Infectious Diseases and Sepsis Clinical Lead, and Consultant in Infectious Diseases & General Medicine, Oxford University Hospitals NHS Foundation Trust (OUHFT); Honorary Senior Clinical Lecturer, University of Oxford
- Professor Peter McCulloch, Patient Safety Academy lead, Professor of Surgery & Fellow of Trinity College, Oxford.
- Clare Hird, Sepsis & AKI Specialist Nurse, OUHFT
- Louise Rawlinson, Matron, Emergency Department (ED), OUHFT
- Dr Ravi Pattanshetty, ED Consultant and ED Sepsis Lead, OUHFT
- Geoff O’Donoghue, Sepsis Patient Representative, OUH Sepsis Working Group & Oxford AHSN Sepsis Stakeholder Group
- Matt Woodward - Human Factors Practitioner, Patient Safety Academy (PSA)
- Dr Clare Dollery, Deputy Medical Director, OUHFT; Chair, Sepsis Stakeholders Group, Oxford AHSN
Sepsis is a major cause of avoidable death. Early recognition and treatment of sepsis might save up to 10,000 lives in the UK each year, but survival falls by up to 7-8% for every hour delay in treatment (Dellinger et al. Intensive Care Med 2012). There has been a national Commissioning for Quality and Innovation (CQUIN) in place for the last 3 years encouraging acute organisations to ensure that patients who have suspected sepsis receive IV antibiotics within 1 hour.
We developed a standardised approach to sepsis management based on NICE sepsis guidance and successful elements of existing systems (Murray & Brent. Clinical Medicine 2018 in press). This has been successfully implemented in acute hospital Trusts in the region. However the proportion of patients with sepsis who receive antibiotics within 1 hour remains below the 90% target locally, regionally (in the AHSN partner organisations), and nationally.
Delays occur at several parts of the patient pathway (figure 1). Further improvement requires a deeper understanding of the remaining barriers to early identification and treatment of patients presenting to the emergency department (ED) with sepsis. Given the substantial efforts and advances already made, significant improvement will require additional approaches.
To understand better the remaining barriers to more rapid recognition, assessment and treatment we propose to apply a formal Human Factors (HF) approach to analysing and redesigning the ED sepsis patient pathway.
Our detailed prospective data (figure 1) show the segmentation of the problem and immediately point to possible areas for study. In each segment, attacking the “tail” of outliers is likely to be more effective than attempting to move the entire distribution leftwards, and the segment most in need of improvement is Alert to Prescription. A HF and ergonomics approach will allow us to understand better the reasons for ongoing treatment delays, and to develop, implement, assess and share effective solutions.
1. Location & stakeholders
The project will be conducted at (OUH). OUH Strengths include:
· Clinical pathways representative of many acute Trusts, including a rapid assessment pathway;
· Electronic patient records and vital signs allow reliable process and outcome data collection to correlate with the qualitative work proposed;
· Unique access to the Patient Safety Academy (PSA a critical mass of professional ergonomic and clinical expertise to ensure delivery. The HF/QI approach described has been successful in recent projects at OUH and elsewhere
· Broad clinical and patient stakeholder involvement (see team details);
· project management and network support from Oxford PSC including access to patients and relatives with lived experience of sepsis.
2. Process Mapping and Human Factors analysis.
Patient Safety Academy (PSA) ergonomist(s) experienced in HF healthcare assessment will develop a detailed process map of the sepsis patient pathway in ED using:
· Ethnographic observation of the current clinical pathway over several days distributed over several weeks
· Structured interviews with staff, patients and relatives with thematic analysis
· Development of Hierarchical Task Analyses for pathway segments allowing a Failure Modes & Effects Analysis (FMEA) to identify areas where improvement would yield maximum benefit
HF specialists will convene multidisciplinary groups including frontline staff and patients to co-design the pathway focusing on improved procedures at identified “hotspots”. The revised pathway will undergo rapid iterative testing using a PDCA cycle approach. An implementation strategy will be developed with management to overcome potential barriers to widespread adoption.
4. Shared learning
We will share learning widely with the following organisations, emphasising the need for local testing and modification by staff co-design groups:
· OUH departments;
· Oxford AHSN partner organisations via regional sepsis stakeholder group and regional ED collaborative
- Potential academic publication
- Q community via Q Exchange pages, blogs, news items and relevant SIGs
We will use the findings to develop a sepsis training package for which we are currently exploring separate funding (see below).
If successful the timing of this bid will allow observation and data collection to be undertaken during the busy winter period. Analysis and process mapping will take place in the spring with interventions piloted in the slightly less busy summer period, prior to full implementation in time for next winter.
Benefits for Q:
Shared learning of project findings (see above).
We are also actively exploring separate funding to co-develop a local and regional (± national) training package with Oxford Simulation, Teaching and Research (OxSTAR).
Successfully implemented, the project will be an exemplar for other projects seeking to apply HF and ergonomics approaches incorporating staff, patients and relatives in a busy ED department setting.
How you can contribute
- • Has work of this nature been conducted for sepsis elsewhere in the UK?
- • Are there any specific elements that would be important to include to maximize the transferability/generalizability of any learning to other settings?
- • What other elements should we consider as part of this project?
Figure 1 OPSSI (PDF, 203KB)