Non Mea Culpa

Matt Hancock tweets that each of the 52,000 annual deaths from sepsis is a preventable tragedy. Tragic yes, but preventable no, certainly not with the current delays between onset of symptoms and first dose of antibiotics.

A shortage of GPs, closure of hospitals, long ambulance journeys and overcrowded emergency departments all conspire against early treatment which is essential when the disease progresses with such alarming rapidity as it does when caused by bacteria such as Neisseria meningitidis. Time from onset of symptoms to first dose of antibiotics is critical. In hospital this means taking blood cultures and immediately giving the first dose of antibiotics, not waiting to measure urine output, blood gas and serum lactate concentration, or waiting until the patient has been reviewed by a senior doctor (all of which receive as much, if not more emphasis, than giving antibiotics in the guidelines championed by Mr Hancock).

In the community it means giving a single dose of antibiotics before moving the patient. Two papers have shown this saves lives. Time to treatment has been emphasised for stroke and heart attacks but not sepsis. NICE guidelines state antibiotics must be given within 1 hour of identifying that a patient meets any high-risk criteria and this is the target on which Trusts will be marked, not on whether there is undue delay in the patients being able to access their GP or being treated once in the hospital. With bacterial doubling times of less than 40 minutes, even this one-hour target is too long.

Sadly, on past experience, it will be the doctors and nurses that will be blamed if the patient does not survive, not the stresses in the system and Mr Hancock’s tweet means the finger of blame is now even more likely to be pointed at the medical and nursing staff. Mr Hancock must address the bigger picture of system failures causing delays to treatment in patients with sepsis and share, not offload, responsibility for the tragic and preventable deaths he describes.

Peter Trewby
Retired Consultant Physician
President North of England Association of Physicians
Treasurer, DFNHS
[email protected]

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