Emergency Departments Support Program

Ministry of Heath

Saudi Arabia

Isam S Osman FRCS

Head Of Vascular and Endovascular Dept.

Director of Operating Rooms

King Saud Medical City

Introduction

• The Sepsis Problem

• The Opportunity

• SCIP Project

• Sepsis Resource Screening

• Sepsis Screening & Data Collection

• SCIP Workshop

• Conclusion

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The Sepsis problem

• WHO announced that Sepsis to be made into a global health priority

• Sepsis worldwide put episodes per year at 31.5 million, with approximately 5.3 million deaths annually

• Episodes of Sepsis are increasing at a rate of 8-13% per year

The Sepsis problem

• Sepsis currently claims more lives than prostate, bowel, and breast cancer combined.

• Relatively low level of evidence for Sepsis

• Various ways to screen for Sepsis and then treat it.

• No ownership for sepsis

The opportunity

• WHO confirms that for each 100,000 population, 400-500 episodes of Sepsis will occur per year

• KSA should see upwards of 128,000 Sepsis episodes per year

• A 50% evidenced mortality suggests 64,000 deaths

• If mortality was reduced to 25% mortality, this would • Save 32,000 lives • Save the KSA health service SAR 1,617

million (£322 million) per year • Improve annual productivity by SAR 8,561

million (£1,709 million)

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Do we care

enough?

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Sepsis Care Improvement

Project (SCIP)

• National initiative under EDSP

• ED based (initial phase)

• Started with 10 cases

• Initially 7 hospitals

• Local and international experts

• International partner

Riyadh

• King Saud Medical City

• King Salman Hospital

• Al Iman Hospital

Jeddah

• King Fahad Hospital

Makkah

• Al Noor specialist Hospital

Alqassim

• King Fahad Specialist Hospital

Dammam

• Dammam Central Hospital

Abha

• Asier Central Hospital

Findings From Eight Hospitals

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Sepsis Resources Screening

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YES, 25%

NO, 75%

Sepsis Protocol Is Available in

Emergency Department?

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Emergency Department Availability

YES, 37%

NO, 63%

BROAD SPECTRUM ANTIBIOTICS IS AVAILABLE IN EMERGENCY DEPARTMENT FLOOR STOCK

YES, 50%

NO, 50%

IS LACTATE TEST AVAILABLE IN EMERGENCY DEPARTMENT?

YES, 75%

NO, 25%

VASOPRESSORS IS AVAILABLE IN EMERGENCY DEPARTMENT?

YES, 37%

NO, 63%

IS ED CONSULTANT AVAILABLE 24 HRS. 7 DAYS A WEEK?

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Sepsis Screening & Data Collection

Sheet

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Baseline

Mortality

50% Almost Half of patients with

sepsis and septic shock die as a result of sepsis

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Antibiotics

47.3% Only 47.3 % of patients received

antibiotics within 3 hours of arrival to Emergency Department

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Lactate

Test

25%

Just 25 % were offered a blood test (lactate )

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

LACTATE

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Blood

Culture

Obtained?

15.7%

Only 15.7 % obtain blood culture within 3 hours of arrival to Emergency Department

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Fluid (30

ml\kg of

Crystalloid –

Normal

Saline)

27.7%

Only 27.7 % receive enough IV fluid within 3 hours of arrival to ED

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Vasopressors

For Septic

Shock

50%

Half of patients with Septic shock

receive vasopressor within 6 hours of arriving to Emergency Department

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What if we Improve Sepsis

Care by

• Compliance with Sepsis Bundles was less than 10% in all the centers

• Increase compliance with

guideline will decrease the mortality

SCIP workshop 16 Sept,

Riyadh, in partnership with UK

Sepsis Trust

• Deputy Minister for Health and senior colleagues

• EDSP leadership Drs Al Qahatani and Otaibi • CEO of UK Sepsis Trust Dr Ron Daniels • Attended by clinical representatives from

ED ,ICU, Nursing from 8 participating hospitals

• Other stakeholders from other hospitals outside the MoH system such as the NGH

• UK partner Escalla

SCIP workshop program

Time Topic Presenter

08.00 Introduction to the Sepsis Project Dr Abdulrahman Alqahtani

08:10 SCIP current status Dr Badr Alotaibi

08.:20 NHS England current thinking on Sepsis Dr Ron Daniels

09.00 NGH experience in Sepsis Dr Sami Alsolami

09:20 SCIP Challenges Dr Badr Alotaibi

09:30 Break

10:00 Sepsis Workshop Project team

11:30 Global Sepsis view Dr Ron Daniels

1300 Change management David Ferris

13:20 Sepsis Workshop Project team

15.00 Discussion and closure 21

National Sepsis Care Improvement

Project

Emergency Departments Support Program (EDSP)

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• Protocol • Guidelines • Care Processes • Equipment • Procedures

Working on

Assemble the experts, the front line clinicians from multiple

discipline and hospitals

Phase one

Phase Two

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Involve all stakeholders in participating hospital , using an information-feedback

process to facilitate everyone's trust, confidence, and buy in.

Test the protocol in the clinical environment using: Plan-Do-Study-Act (PDSA) Cycles.

Measure the protocol’s impact on work processes and outcomes.

Emergency Departments Support Program (EDSP)

01 02 03

Phase Three – National Implementation

Emergency Departments Support Program (EDSP)

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• Making Change • Scale up • Spread

Making change permanent on a pilot hospital

Overcoming systemic barriers that emerge while implementing

Overcoming infra-structure issues that would inhibit implementation and spread

Replication of change with other hospitals

Conclusion

Sepsis in KSA is a challenge we must all own

EDSP is preparing the final draft of an 8 hospital pilot scheme to improve sepsis recognition and treatment in a standardized evidence based and time sensitive fashion

Next steps will be to scale across the country and in other sectors

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Components of SIRS, qSOFA, MEWS, and

NEWS

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