Beginning in 2014, each acute care hospital in New York State (NYS) that provides care to patients with sepsis was required by amendment of Title 10 of the New York State Codes, Rules and Regulations (Sections 405.2 and 405.4) to develop and implement evidence-informed sepsis protocols, which describe their approach to both early recognition and treatment of sepsis patients. In addition, hospitals were required to report data to the Department beginning in 2014 that are used to calculate each hospital’s performance on key measures of early treatment and protocol use. Hospitals were also required to submit clinical information for each patient with sepsis to allow the Department to develop a methodology to evaluate ‘risk adjusted’ mortality rates (RAMR) for each hospital. Risk adjustment takes into consideration the different mix of characteristics and comorbid conditions, including sepsis severity, of patients cared for within each hospital and permits comparison of hospital performance. Weniger anzeigen

Sepsis ist die Nummer eins der vermeidbaren Todesursachen im Krankenhaus und gilt deshalb als Maßstab für die Qualität eines Gesundheitssystems. In Deutschland liegt die Sepsis-sterblichkeit im Krankenhaus bei 41,7%. Dies ist deutlich höher als in Großbritannien (32,1%), in den USA (23,2%) und in Australien (18,5%). Die Gründe hierfür liegen in Schwächen von Strukturen und Verantwortlichkeiten im deutschen Gesundheitssystem. Der folgende Bericht analysiert Strukturen und politische Reaktionsmuster in Ländern mit niedrigerer Sepsissterblichkeit und zeigt an deren Beispiel effektive Maßnahmen und Reaktionsmuster auf. Zur Überwindung der bestehenden Defizite in Deutschland wird empfohlen, einen verbindlichen Nationalen Sepsisplan zu verabschieden. Weniger anzeigen

1. Sepsis arises when the body’s response to infection injures its own tissues and organs. It can lead to septic shock, multiple organ failure and death, if not recognized early and managed promptly. It is a major cause of maternal and neonatal morbidity and mortality in low- and middle-income countries and affects millions of hospitalized patients in high-income countries, where rates of sepsis are climbing rapidly. The present report summarizes the problem of sepsis as a key issue for global health, describes the Secretariat’s actions to address it and briefly outlines priority actions for the future. 2. An international consensus has recently recommended that sepsis should be defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection” and septic shock as “a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone”. Both definitions are accompanied by clinical criteria to translate them into practice to support diagnosis and clinical management during patient care. Weniger anzeigen

Ziel dieses Reports ist es, die medizinische und gesundheitsökonomische Rationale für die Notwendigkeit eines Nationalen Sepsisplans zu dokumentieren. Die wichtigsten Handlungsfelder und notwendigen Maßnahmen werden thematisiert und die Akteure benannt, die unter der Federführung des Bundesministeriums für Gesundheit für die weitere Ausarbeitung und Konkretisierung des Sepsisplans sowie die Erreichung seiner Ziele gewonnen werden müssen.

„Some very important clinical issues, some of them affecting life and death, stay largely in a backwater which is inhabited by academics and professionals and enthusiasts, dealt with very well at the clinical and scientific level but not visible to the public, political leaders, leaders of healthcare systems. . . . The public and political space is the space in which [sepsis] needs to be in order for things to change.” So said Sir Liam Donaldson, the former chief medical officer for England and the current World Health Organization (WHO) envoy for patient safety, on May 24, 2017. Two days later, the World Health Assembly (WHA), the WHO’s decision-making body, adopted a resolution on improving the prevention, diagnosis, and management of sepsis. Weniger anzeigen

Das Bewusstsein über Sepsis, die Bedeutung des Krankheitsbildes und Kenntnisse über Sepsis Symptome innerhalb der Bevölkerung in Deutschland wurde in einer neuen, repräsentativen Umfrage erfasst. Ziele und Methoden der Umfrage: Die letzte Umfrage vom Juli 2013 zeigte, dass nur etwa 50% der Bevölkerung den Begriff Sepsis kennen. Seitdem wurden verschiedene Aufklärungsmaßnahmen zum Thema Sepsis durchgeführt. Sepsis war zudem regelmäßig Thema in Fernseh-, Rundfunk und Pressebeiträgen. Ziel der neuen Umfrage war die Erfassung des aktuellen Wissenstands innerhalb der Bevölkerung in Deutschland. Dabei wurde dieselbe Methode wie 2013 (CATI/Omnibus) angewandt. Die Umfrage wurde wie 2013 von TNS Infratest mit 1014 repräsentativen Teilnehmern durchgeführt. Auftraggeber war die Sepsis Stiftung. Zusätzlich zum Umfang von 2013 wurden in der aktuellen Umfrage der Kenntnisstand zur Bedeutung von Sepsis als Krankheitsbild sowie zu Sepsis Symptomen erfasst. Weniger anzeigen

• Awareness level for hearing the term sepsis has risen significantly to 55% • Only 13% know of someone who has had sepsis or had sepsis themselves, yet more than 1 million are affected each year • There are now 25 million more adults that are aware of sepsis compared to 2015. • Sepsis is still most heard of through news and entertainment. • Majority of adults are not sure what the most common symptoms of sepsis are, less than 1/3 could correctly identify all them. • Sepsis in the media continues to rise with the announcements of the cause of death with Patty Duke and Muhammad Ali. Sepsis awareness levels have risen for the first time in 3 years. However, there is still a large group that are not aware of the term. Women continue to be more aware then men. • News and entertainment continue to be a major source of where adults hear of sepsis. • Sepsis is a big unknown. Most adults are unable to identify the most common symptoms, nearly 2/3 are just not sure what they are. Weniger anzeigen

Sepsis is defined as an overwhelming response to infection in which the immune system initiates a potentially damaging systemic inflammatory response syndrome (SIRS) which can manifest in a number of physiological changes, recognised by worsening vital signs or ‘SIRS criteria’ (temperature, respiratory rate, heart rate). Severe sepsis is defined as sepsis leading to dysfunction of one or more organ systems according to current criteria. This year, international consensus definitions will be amended to focus on physiological changes of organ dysfunction, including hypotension, tachypnoea and altered mental state. Sepsis is already recognised as difficult to diagnose and it can only be hoped that a new definition will aid this process. However, whichever definition is used it is the wider consideration given to sepsis by healthcare professionals that is important. Over 70% of cases of sepsis are believed to arise in the community. General practitioners and other pre-hospital services present key opportunities for prompt recognition and treatment of sepsis. Patients requiring hospital care may be admitted through emergency departments or admissions units, where the same issue of prompt recognition is equally important. In 2011, the Royal College of Emergency Medicine conducted an audit of compliance with sepsis management standards in emergency departments. Compliance was found to be suboptimal at 27-47%. A repeat audit in 2013-14 showed mixed results with marginal improvement. Weniger anzeigen

This is our first clinical report. It focuses on ten cases we investigated where patients did not receive the treatment they urgently needed. In every case, tragically, the patient died. Sepsis is a significant cause of death and disability in the UK. We want complaining to make a difference and so we are publishing our first clinical report. It focuses on ten complaints we investigated about patients with severe sepsis who did not receive the treatment they urgently needed. In every case, tragically the patient died. In some cases, with better care and treatment, they may have survived. The Ombudsman can support the drive for a patient-centred NHS by shining a light on issues raised with us by patients and their families. We would like to thank the families in this report who have allowed us to tell their stories. The crucial lessons to be learnt from this report all derive from concerned people raising complaints about the care received by their loved ones, and pursuing that complaint with us when they do not receive a satisfactory outcome. In doing so they are performing a valuable public service. We know that many do not complain because they feel it will make no difference. Our job is to make sure it does. We have worked closely with NHS England, NICE, UK Sepsis Trust, the Royal College of Physicians, the Royal College of Surgeons, and the College of Emergency Medicine to find solutions to the issues identified in our report. We are now looking to these organisations and others to make the necessary changes to improve NHS care. We know it is not easy to spot the early signs of sepsis, but if we learn from these complaints and work to improve diagnosis and provide rapid treatment, then lives can be saved. Weniger anzeigen

Der Begriff Sepsis ist in der Öffentlichkeit und bei Laien unzureichend bekannt und verstanden. Er wird meist mit Blutvergiftung assoziiert. Die meisten Menschen wissen nicht, dass Sepsis die schwerste Verlaufsform und Haupttodesursache von Infektionen ist. Sepsis ist eine generalisierte, den ganzen Körper und seine Organe schädigende Entzündungsreaktion, die sich aus fast jeder lokal begrenzten Infektion entwickeln kann. Ohne adäquate und rechtzeitige Therapie verläuft eine Sepsis fast immer tödlich. In Deutschland erkranken jährlich ca. 180.000 Menschen an einer Sepsis, ca. 60.000 dieser Menschen versterben. Dies bedeutet, dass in Deutschland mehr Menschen an Sepsis versterben als durch Herzinfarkt oder Lungen-, Brust- und Dickdarmkrebs zusammen. Bis zu 20% der Sepsisüberlebenden leiden noch jahrelang an schweren Beeinträchtigungen wie dem posttraumatischem Stresssyndrom, motorischen und neurokognitiven Funktionsstörungen, Depressionen und Kachexie. Die Zahl der Sepsisfälle nimmt in den Industrienationen jährlich um ca. 7 bis 8 % zu. Septische Komplikationen limitieren den Therapieerfolg wesentlicher Behandlungsmethoden der Hochleistungsmedizin und stellen neben dem menschlichen Leid eine enorme gesundheitsökonomische Herausforderung dar. Weniger anzeigen