The hospital network (Trust) comprises of 5 main sites. In recent years, the Trust had over 1 million outpatient contacts, quarter of a million ED attendances, 200 000 inpatient contacts, and 100 000 inpatient operations. The Trust employs more than 2500 doctors, 4000 nurses, 720 allied healthcare professionals, and 130 pharmacists.

Work to improve care for sepsis patients at the Trust centers on 3 key priorities: The identification and treatment of sepsis across the whole patient pathway Consistency of standards and reporting The prudent use of antimicrobials within the wider antimicrobial stewardship and resistance agenda.

A key focus has been to ensure that patients identified with sepsis receive the appropriate antibiotics within 1 hour, in line with national targets. The work is integrated with the digital transformation and the use of an embedded digital sepsis alert in the EHR.

The digital sepsis alert embedded in the EHR and available to the Trust is the St John Sepsis Algorithm.

Implementation of the alert was part of a collaborative improvement approach through the Sepsis Big Room. A “big room” is a weekly coached meeting which provides time and space for a range of staff to come together to discuss improvements to the quality of patient care. Staff from all disciplines are welcome and the meetings operate a flattened hierarchy. Patient stories are reviewed and real-time data displayed to support the identification of specific improvements to healthcare processes within the pathway of care. In an approach similar to one others have used, a series of tests of change were undertaken to improve decision making and communication for sepsis patients. For each test, a small-scale Plan-Do-Study-Act cycle, based on Toyota Big Room methodology,23,24 was performed and, if this proved successful, the test was tried more widely. Data from the evaluation were used to provide feedback to the team and shape discussion on implementation. A key aspect of work undertaken by the Sepsis Big Room was the development of “Treatment Plans” for specific diagnosis which are embedded in the EHR system. A sepsis treatment plan was developed, which includes relevant investigations, fluids, oxygen prescriptions, and specific antibiotics according to guidelines. This is in line with the Institute for Healthcare Investigations sepsis bundle.25