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NICE sepsis guideline: ‘devil is in the detail’ – Dr Mark Holland

Dr Mark Holland, president of the Society for Acute Medicine, said: “In 2015, the NCEPOD report ‘Just Say Sepsis’ showed that the specialty of acute medicine cares for over half of all patients admitted to hospitals with sepsis

“The Society for Acute Medicine (SAM) therefore welcomes the NICE guideline ‘Sepsis: recognition, assessment and early managementIt goes without saying that we fully endorse the ethos and values of the guideline.

“As always, though, the devil is in the detail. During the consultation period, SAM questioned NICE regarding the recommendation [54] for any patient not responding within one hour to initial treatment to see a consultant. While this is a laudable aim, we feel this recommendation, based on consensus opinion as opposed to definitive evidence, needs to be refined. 

“SAM fully supports early senior decision making, however, our current workforce numbers do not afford the resource of a consultant physician being on site in every hospital 24 hours a day. We would be keen to work with colleagues in emergency medicine and critical care medicine to look at more practical ways of enhancing consultant delivered care. 

“We would also highlight the work we have undertaken in recent years implementing track and trigger tool measures, coupled with care bundles, for sepsis patients. The impact of this work may not have been picked up in NICE’s review of the evidence.

In acute medicine we favour the National Early Warning Score (NEWS). NEWS has been prospectively validated in large numbers of patients and, in our opinion, is the best tool available for identifying sick patients and those at highest risk of deterioration. Although NEWS it not specific to sepsis, we feel it is superior to similar tools. 

“In acute medicine we see a diverse mix of sick patients, not all of whom have sepsis. In our routine assessments we need a validated tool to risk-stratify and physiologically grade patients with a variety of diagnoses and, to that end, we believe NEWS is the best tool.

“NICE guideline 51, ‘Sepsis’, is an important step forward for this serious condition. 

“SAM wishes to actively engage with colleagues in other specialties to improve care for patients with sepsis. As the majority stakeholder in caring for patients with sepsis, we regularly devote time to the condition at our meetings. This will continue at our 10th International Scientific Meeting, jointly hosted with the Royal College of Physicians of Edinburgh (September 12-13, Edinburgh), where we have assembled a world-class field of experts to debate sepsis with our members.”

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