Investigation after spike in sepsis cases at Royal Bolton Hospital's maternity unit
HEALTH watchdogs have prompted an internal review into the number of women diagnosed with sepsis in the maternity unit at the Royal Bolton Hospital.
The Care Quality Commission (CQC) raised an “alert” with the hospital after noticing a spike in sepsis cases among women who have recently given birth.
Hospital bosses say the rise is down to the heightened awareness of the symptoms of sepsis among clinical staff.
The CQC monitor the number of cases of sepsis — a common, yet potentially life-threatening, condition triggered by infection — to spot any unusual trends or “outliers” in patient care.
Symptoms of sepsis include a high temperature, a fast heart rate and fast breathing — all symptoms that can also be brought on by childbirth.
Hospital chiefs say staff are either identifying more cases at an earlier stage or misinterpreting the symptoms brought on by labour as sepsis — even when it may not be the case.
The maternity figures do not relate to mortality rate or cause of death.
Dr Jackie Bene, chief executive of the Bolton NHS Foundation Trust, said: “The higher proportion of cases being reported in the notes as sepsis for the period in question coincided with a drive by the trust to recognise sepsis and act to treat quickly — sepsis can be very serious.
“What we believe happened is that at a time of heightened awareness of sepsis, some cases were being recorded in the notes as sepsis even though the symptoms can be caused by other factors.
“This is particularly the case for women at the time around and soon after childbirth.
“It is important to note, however, that many of the women recorded as having sepsis did indeed have sepsis and as a result of this being identified early, were treated quickly and appropriately.”
The CQC has asked the trust to carry out internal analysis on the way sepsis cases are recorded in patient notes and coded for hospital data.
A spokesperson for the CQC said: “Thus far the expert panel has considered the analysis presented and, given that this has not been able to explain the trust’s outlying status for the indicator, we have written to ask for further information.
“The trust was given four weeks to answer our questions and their response has now been received.”
Last year the Royal Bolton Hospital was cleared of any wrongdoing following reviews into the way it codes sepsis cases.
The independent investigation, led by Kathy Doran, an experienced chief executive from Cheshire, Wirral and Warrington PCT cluster, and Dr Peter Williams, medical director at Royal Liverpool and Broadgreen University Hospitals Trust, with the help of Ron Daniels, chief executive of the Sepsis Trust UK, was launched in March after the Dr Foster review found coding did not meet national standards and had been retrospectively changed.
The alarm was initially raised by Dr Foster after finding that there were 800 cases of septicaemia at the hospital between March, 2010 and April, 2011, when a similar-sized trust would be expected to have had 200.
But the review showed that whilst coding at the Trust does not meet the standard Dr Foster criteria, patient care at the Trust is excellent.
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