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Group B Streptococcus (GBS) is the leading cause of serious bacterial infection in the first few weeks of life and is a major global cause of neonatal meningitis, sepsis and pneumonia. This report examines clinical negligence claims related to early onset GBS disease in neonates. The analysis reviewed 19 closed claims notified between January 2016 and March 2023, of which 11 were settled with damages paid. The total cost of these closed claims was £1,430,894, including claimant legal costs, NHS legal costs and damages. The report makes practical recommendations for maternity and neonatal services, including improved triage systems, robust processes for tracking and communicating test results, and enhanced staff training in recognising signs of sepsis. Did you know? Most babies in this group were symptomatic within the first 24 hours of life. Most babies in this cohort presented as being unwell at the time of birth or with early jaundice or poor feeding. 79% of infants required a prolonged inpatient admission, with the mean stay being 6.6 days and the maximum being 21 days. Across all these claims, this included days on neonatal units (NICUs), paediatric intensive care units (PICUs), postnatal wards and paediatric wards. Only 25% of babies in this group received antibiotics within the nationally recognised 1-hour target. In this group of babies with early onset GBS disease, the proportion of mothers known to be colonised during pregnancy, found to be colonised during or after the delivery, and not known to be carrying GBS at all were almost equal (i.e. around a third in each of these categories). Further reading on the hub Top picks: 7 resources about Group B Strep

Sepsis, life-threatening acute organ dysfunction due to infection, is a global health priorit with approximately 49 million cases and 13 million sepsis-related deaths each year. Beyond being acutely deadly, sepsis contributes to new and worsened physical, cognitive, and mental health problems in many survivors. Early identification and treatment are critical to improving outcomes. The Surviving Sepsis Campaign (SSC) guidelines are intended to support clinicians caring for adult patients with sepsis, focusing on management in the hospital, the immediate prehospital setting, and the immediate post-hospital setting. These guidelines incorporate principles of antimicrobial stewardship through responsible antimicrobial use, proper diagnostic strategies, and de-escalation of antimicrobial therapy. The recommendations reflect evidence-based best practice, distilling a large body of research into actionable recommendations. They empower individuals and health systems to make informed choices about care and support improvements in management and outcomes of sepsis. Further reading on the hub: Spotting the signs of sepsis: a series of short videos Top picks: 13 resources about sepsis

Terrence Frost’s death was verified at 00:26 on 18 July 2024, at the Ipswich Hospital, in Ipswich, Suffolk, although Terrence’s death had occurred earlier at approximately 22:20 on 17th July 2024. On the 11 July 2024 Terrence was admitted to the Ipswich Hospital for an elective surgery (angioplasty) to improve the blood flow to his left leg and foot. Terrence was discharged on the following day 12 July 2024. On the 14 July 2024 Terrence was admitted again to the Ipswich Hospital with abdominal pain and rectal bleeding. No diagnosis was made, and as this settled spontaneously, Terrence was discharged again on the 15 July 2024. On the 16 July 2024, due to concerns raised by his family, a GP’s Paramedic conducted a home visit, and following subsequent concerning blood test results Terrence was told to go back to Ipswich Hospital as a failed discharge. After a prolonged period in the Accident and Emergency department Terrence was readmitted to the Ipswich Hospital. Despite testing, no definitive diagnosis was made during Terrence’s final admission, and Terrence appeared reasonably stable until he suffered a sudden collapse and cardiac arrest at 21:22 on the 17th July 2024. A subsequent postmortem examination identified that Terrence suffered from significant cardiac disease (cardiomegaly and coronary artery disease) and significant vascular disease (systemic atherosclerosis). The pathologist identified that his clinical markers identified that sepsis played a factor in Terrence’s death, although evidence of any infection could not be found. MATTERS OF CONCERN Evidence was heard that prior to his attendance in the Accident and Emergency department on the 16 July 2024, Terrence had been seen at home by a paramedic from his surgery, who was concerned by Terrence’s presentation and wanted to admit him to hospital. However, Terrence was reluctant so it was agreed that urgent blood tests would be taken in the first instance. The results of these tests were seen by a GP, and due to the findings (which indicated a possible serious infection or inflammation) the GP called Terrence and told him to go straight to hospital, and whilst enroute she would speak to the Medical Assessment Unit. In evidence the GP said she then spent 30 minutes on the telephone trying to contact the Medical Assessment Unit as is the required procedure, to discuss Terrence’s admission. After being unable to contact the Medical Assessment Unit, the GP contacted Terrence, via a family member, and told him that as she could not contact the Medical Assessment Unit he should head to the Accident and Emergency department instead. The GP told Terrence she would pre- alert the Accident and Emergency department to his arrival. The GP then spent a further period of time telephoning the Accident and Emergency department but again could not get through. As such upon arrival, a patient who was considered by their GP to be significantly unwell enough to warrant either admission to the Medical Assessment Unit, or that Accident and Emergency should be pre-alerted to their arrival, was unable to speak to either unit prior to the patient’s arrival. Terrence endured a 5 hour wait in Accident and Emergency before being seen. Although observations taken at the time of his subsequent admission suggest he had not developed sepsis at this stage, I am concerned that the inability of a GP to be able to promptly communicate with either the Medical Assessment Unit or Accident and Emergency department may lead to future deaths in cases where suspected sepsis or other life threatening conditions have been differentially diagnosed, especially if those conditions have progressed further than Terrence’s had at the time of his arrival. I am further concerned that evidence was heard from a clinician based at the Ipswich Hospital itself, that they too found contacting the Medical Assessment Unit extremely difficult, with internal hospital telephone calls frequently going unanswered.

Dr Ron Daniels is joined by journalist and campaigner Kath Sansom, founder of Sling The Mesh, to discuss the complications linked to surgical mesh and why fully informed consent is crucial for anyone considering surgery.Drawing on her own experience and a decade of advocacy, Kath shares how inadequate information and follow-up have left thousands facing life-changing pain and recurrent infections – some of which can progress to sepsis.Together, the pair explores how to improve patient safety, strengthen regulation, and ensure every voice is heard.

In this interview, Dana Edelson, an expert in cardiac resuscitation at the University of Chicago, discusses how hospitals can best use early warning score tools to risk stratify patients—without adding to clinicians’ alarm fatigue. Dana recently co-authored a study which compared six different early warning scores designed to recognise clinical deterioration in hospitalised patients, including three proprietary AI tools.

The early recognition of sepsis and septic shock is crucial for improved patient outcomes. Quality improvement programs have ameliorated processes and outcomes in the care of patients with sepsis and septic shock. This study in the Journal of Patient Safety aimed to improve the proportion of patients receiving antibiotics within one hour of triage and compliance with sepsis bundles. A multidisciplinary sepsis task force was created to monitor and improve sepsis care. The program lasted 24 months from January 2018 to December 2019. A unique screening criterion was created by combining items from the systemic inflammatory response syndrome, quick sequential organ failure assessment, and National Early Warning Score systems. After this initial stage, a sepsis flowsheet was implemented in the emergency department for monitoring. The measures between the first 12 months and the last 12 months were compared and showed that: the proportion of patients receiving antibiotics within one hour of triage improved from 44% to 84%. intravenous crystalloid administration within three hours improved from 62% to 94%. serum lactic acid measurement within three hours improved from 62% to 94%. vasopressor initiation within six hours improved from 76% to 94%. mortality rates decreased from 32% to 21% between the 2 study periods.

This article in JAMA aimed to assess whether electronic sepsis screening based on quick Sequential Organ Failure Assessment score (qSOFA), compared with no screening, reduces the mortality of patients admitted to hospital wards. It was carried out as a stepped-wedge, cluster randomised trial at five hospitals in Saudi Arabia. The results show that among hospitalised ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality.

The death of nine-year-old Dylan Cope at University Hospital of Wales could have been avoided and neglect contributed, a coroner has concluded. Giving a narrative conclusion, senior coroner for Gwent Caroline Saunders, said Dylan’s death would have been avoided had he not been discharged from Grange University Hospital, Cwmbran, on 7 December 2022. This article, pushed by Leigh Day law firm, describes the events leading up to Dylan's death, the coroners findings, and includes an account from Dylan's mother.

This cohort study examined how hospital six early warning scores compare with one another, based on 362,926 patient encounters. The authors compared three proprietary artificial intelligence (AI) early warning scores: Simultaneous Epic Deterioration Index (EDI) Rothman Index (RI) eCARTv5 (eCART) against three publicly available simple aggregated weighted scores: Modified Early Warning Score (MEWS) National Early Warning Score (NEWS) NEWS2 scores. In the study, eCART outperformed the other AI and non-AI scores, identifying more deteriorating patients with fewer false alarms and sufficient time to intervene. NEWS, a non-AI, publicly available early warning score, significantly outperformed EDI. The authors concluded that, given the wide variation in accuracy, additional transparency and oversight of early warning tools may be warranted.

Tamara Davis died on 13 December 2022 at the Royal Sussex County Hospital, Eastern Road, Brighton from multi organ failure which developed due to bronchopneumonia caused by influenza A infection. She had been admitted to hospital on 10 December 2022 having been unwell for 5 days. She was assessed in Resus within the Emergency Department (ED) when her NEWS score was 8. She was treated for a suspected chest infection with IV antibiotics, fluids and paracetamol in the early hours of 11 December. Her clinical condition then appeared to be improving. She was moved into the ED corridor at 05:30 on 11 December as this was in use for patients. She then waited to be admitted to a ward for further treatment and observation. She remained in the ED corridor until 15:20 on 11 December. Tamara then moved to a cubicle in Majors within the ED and thereafter she experienced a significant deterioration in her condition which was treated and resulted in her admission to Intensive Care Unit. Despite treatment with supportive therapy she died on 13 December 2022. Coroner's matters of concern During the inquest I heard evidence from clinicians at University Hospitals Sussex NHS Foundation Trust that when the Emergency Department of the Royal Sussex County Hospital, Brighton reached capacity patients would be moved to and treated in the corridor as there was no clinical area available to do so. The area is not designated as a clinical area and is not included within the Nursing staffing template for the ED. When Ms Davis was treated in the Royal Sussex County Hospital, Brighton on 11 December 2022 there were, at times, more than 20 patients in that area. Clinicians from University Hospitals Sussex NHS Foundation Trust gave evidence as to the action that is being taken by the Trust currently to (1) reduce the number of patients who present to the Emergency Department who could be seen by other services in the community and (2) to create an improved patient flow through the Royal Sussex County Hospital. The evidence was however that, despite these actions, the corridor remains in use for patients currently as there is insufficient space within the department to care for patients. There was no evidence as to when, and if, this practice would no longer be necessary. I heard that the provision of care in the ED corridor meant that patients lacked privacy, toilet facilities and confidentiality. I understood from the evidence of the clinicians that they were concerned that patients were being moved into the Corridor but there appeared to be no other option when the Emergency Department exceeds capacity. I heard that in the event of a major incident University Hospitals Sussex NHS Foundation Trust would have to clear the Emergency Department, as they had done on occasion, as this would be the only way to create the necessary clinical space when the department was already over capacity and using the corridor. I was also advised that the use of corridors to care for patients is not only an issue at the Royal Sussex County Hospital, Brighton but is used throughout the country when the capacities of Emergency Departments has been reached and there is nowhere to move patients to.

Clinical decision support (CDS) systems, which aim to support healthcare professionals in making more efficient and evidence-based decisions, are now prevalent in clinical practice. Although many CDS tools, such as clinical calculators and automated order sets, involve low complexity, other CDS systems incorporated into electronic health records are increasingly sophisticated, deployed in time-sensitive settings and built on artificial intelligence (AI) or machine-learning models. This Lancet article looks at the reasons why CDS tools might pose unclear or unacceptable risks to patient safety and equitable care.