An editorial published in the BMJ by Paul Morgan and me discusses the importance of getting the balance right in the diagnosis and treatment of sepsis. Public and professional understanding of sepsis has increased greatly in recent years. This has led to campaigns to diagnose sepsis early in the clinical course of the illness and to start treatment with antibiotics and fluid replacement promptly. Examples include the Survive Sepsis campaign, which led to the creation of the UK Sepsis Trust, and the establishment of the Global Sepsis Alliance and World Sepsis Day. But could this pressure to improve sepsis management be counterproductive and lead to overdiagnosis of sepsis?
NHS England estimates that approximately 37 000 deaths a year are caused by sepsis. This means that in the seven year period between 2011 and 2017, around 259 000 people died from sepsis in England. Only one of these deaths, that of Jack Adcock in Leicester in 2011, has resulted in the conviction of health professionals for manslaughter (Hadiza Bawa-Garba and Isabel Amaro).
Sepsis can be difficult to diagnose, and delays and omissions in its diagnosis and treatment contribute to the high death rate. Even the former chair of the General Medical Council, Graham Catto, has admitted that he failed to diagnose sepsis in a timely manner, an error that contributed to a patient’s death. Because of the problems diagnosing and treating sepsis, numerous initiatives have aimed to improve its management in both primary care and hospital settings. Details of one of the most recent of these initiatives were published by NHS England in September 2017.
Given the scale of death from sepsis and the many delays and errors so often seen in its management, why were Bawa-Garba and Amaro convicted of gross negligence manslaughter? Was their management of Jack Adcock so different from the management of other cases of sepsis that resulted in death that they were justly convicted? Or were they involved in just one of many cases where suboptimal management of sepsis contributed to death? NICE guidance NG51 and Quality Standards QS161 have only recently set out the expectations of best practice in sepsis care—several years after Bawa-Garba and Amaro were charged.[5,6]
We need an objective review of sepsis deaths to identify the contribution of suboptimal management to the death and to recognise lessons for the future in a non-judgmental manner, not the prosecution of health professionals, if we are to improve clinical outcomes for patients with sepsis.
1. NHS England. Improving outcomes for patients with sepsis A cross system action plan. December 2015. https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf
2. Ladher N, Godlee F. Criminalising doctors. BMJ2018;360:k479.doi:doi:10.1136/bmj.k479pmid:29419388
3. NHS National Patient Safety Agency. Medical Error. August 2005. http://www.nrls.npsa.nhs.uk/resources/?EntryId45=61579
4. NHS England. Sepsis guidance implementation advice for adults. September 2017. https://www.england.nhs.uk/publication/sepsis-guidance-implementation-advice-for-adults/
5. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. NICE guidance NG51. July 2016. https://www.nice.org.uk/guidance/ng51
6. National Institute for Health and Care Excellence. Sepsis. Quality Standard 161. September 2017. https://www.nice.org.uk/guidance/qs161