SEPSIS KILLS program
Sepsis is a time critical medical emergency and a leading cause of death worldwide.1 In Australia at least 55,000 people develop sepsis each year and 8,000 of them die from sepsis-related complications.2 The SEPSIS KILLS program has been incrementally introduced since 2011 in more than 200 health facilities in NSW. Sepsis care has been greatly improved with recognition and treatment occurring more rapidly and sepsis-related patient deaths have decreased by 30%.3
Sepsis is the immune system's response to an infection which causes the body to attack its own tissues and organs. It can occur in response to any bacterial, viral or fungal infection acquired in a community or healthcare setting. If sepsis is not treated quickly, it can lead to organ failure and death. The international clinical definition of sepsis is 'life-threatening organ dysfunction caused by a dysregulated host response to infection'.4
The aim of the SEPSIS KILLS program is to improve recognition and treatment and reduce preventable harm to patients with sepsis. Three key clinical actions underpin the program to support rapid and reliable identification and treatment:
- RECOGNISE the risk factors, signs and symptoms of sepsis
- RESUSCITATE with rapid intravenous fluids and antibiotics
- REFER to senior clinicians and specialty teams for source control, specialist care and retrieval if required
These actions are explained in the video below.
The SEPSIS KILLS program directly links with the Between the Flags system (BTF) which is a 'safety net' to assist clinicians to recognise when patients are deteriorating and to respond appropriately when they do. It also links with the NSW Health Policy Recognition and management of patients who are deteriorating (PD2020_18) and the Australian Commission on Safety and Quality in Health Care's Sepsis Clinical Care Standard.
The SEPSIS KILLS program has been a leader in sepsis improvement and the CEC has worked collaboratively to share key learnings and resources. A number of Australian states and territories have undertaken sepsis initiatives to improve prompt recognition and management. The combined learnings have contributed significantly to the development of the National Sepsis Program led by the Australian Commission on Safety and Quality in Health Care.
Five inter-dependent elements are needed to deliver improved and sustainable systems for recognition and response to patients with sepsis:
- Governance: structures and processes to support implementation, management and quality improvement at local health district (LHD) and specialty health network (SHN), facility, clinical service and clinical unit level.
- Clinical Emergency Response System (CERS): a local system for the escalation of care that is used by staff, patients, carers and families.
- Sepsis tools: to guide clinical decision making in parallel with the local CERS.
- Education: to ensure appropriate skills and knowledge for the recognition and management of patients with sepsis.
- Evaluation: an evaluation strategy that includes a family of measures (outcome, process and balancing measures) for monitoring the performance and improving the effectiveness of sepsis care.
For more information on the five elements, please refer to the NSW Health Policy Directive Recognition and management of patients who are deteriorating (PD2020_18).
Evaluation of the SEPSIS KILLS program is conducted at (1) local level by health facilities and (2) statewide by the CEC to measure the impact of the program and improvements in sepsis care.
Local evaluation enables a facility to know if they are providing safe, effective and reliable sepsis care for every patient, every time. A Sepsis Measurement Framework is available to provide a guidance on selecting relevant local quality improvement measures. A range of outcome, process and balancing measures can be selected and local measures can also be included.
Data collection and analysis can be undertaken in the web-based Quality Improvement Data System (QIDS) for an improvement project using the Sepsis Toolkit or the CEC Sepsis Database for ongoing monitoring. Other locally agreed monitoring systems can be used and advice can be sought from the CEC team to determine the best data collection method for your needs.
NSW statewide evaluation is undertaken by the CEC to measure the impact of the program on the statewide health system and patient care outcomes.
The SEPSIS KILLS program initial outcomes (2011 – 2013) were published in the Medical Journal of Australia and results showed that the program had significantly improved the process of care for patients in emergency departments in NSW public health facilities. The proportion of patients who received antibiotics within 60 minutes of triage or recognition increased from 29.3% in 2009–2011 to 52.2% in 2013 (P < 0.001). Similarly, the number of patients who started a second litre of intravenous fluid within one hour rose from 10.6% to 27.5% (P < 0.001).
During the run-in period of 2009–2011, sepsis-related mortality was 19.3%. This rate declined to 17.2% in 2012 and 14.1% in 2013 and there was a significant linear decrease over time (P < 0.0001); the OR for death (compared with the run-in period 2009-11) was 0.87 (95% CI, 0.80–0.94) in 2012, and 0.69 (95% CI, 0.63–0.74) in 2013. Significant linear declines were also observed for time in intensive care and length of stay (for each trend: P < 0.0001).
The program was awarded an international Global Sepsis Award from the Global Sepsis Alliance and the MJA/MDA National Prize for Excellence in Medical Research in 2016.
- Rudd, K, Johnson, S, Agesa, K, et al., 2020, 'Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study', Lancet, 395(10219):200-11.
- Australian Sepsis Network. https://www.australiansepsisnetwork.net.au/ssnap/stopping-sepsis-national-action-plan. Accessed 13 December 2021
- Burrell, A, McLaws, M-L, Fullick, M, et al., 2016, 'SEPSIS KILLS: early intervention saves lives', Medical Journal of Australia, 204 (2): 73.
- Singer, M, Deutschmann, C, Seymour, C, et al., 2016, 'The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)', Journal of the American Medical Association, Feb 23; 315(8) 801-810.