Sepsis is often thought of as an acute hospital emergency. But if we want to improve outcomes, some of the greatest opportunities may lie much earlier – in preventing infection, recognising deterioration sooner and designing better pathways across community care.
Dr Natasha Curran, Medical Director at the Health Innovation Network South London, sat down with Programme Directors Catherine Dale (Patient Safety) and Sara Nelson (Innovator Support) to discuss some of the often-overlooked aspects of sepsis, and where opportunities for improvement and innovation might lie.
Sepsis and the shift towards prevention
When most healthcare professionals think about sepsis, they think about emergency departments, critical care units and the rapid delivery of life-saving treatment.
Yet sepsis does not begin at the hospital door. In most cases, it starts in the community – and for many patients, its impact continues long after discharge.
This broader perspective is increasingly reflected in national policy. The NHS England Sepsis Modern Service Framework recognises that improving outcomes requires a whole-pathway approach, spanning prevention, early recognition, timely escalation, treatment and recovery.
It also reflects the wider direction of healthcare: moving from reactive treatment towards prevention, earlier intervention and more integrated models of care.
For busy healthcare professionals who may not have had time to read the framework in detail, the key message is simple: sepsis should not be viewed solely as an acute hospital problem. It is a system-wide challenge that requires action across the whole patient journey.
The hidden impact of sepsis
Awareness of sepsis has improved significantly over the past decade. In 2016, we played our part in a concerted national push led by government and the UK Sepsis Trust, developing a video that went on to be watched almost three million times on social media.
Those efforts have helped establish sepsis as a widely recognised medical emergency. But knowing the word ‘sepsis’ is not the same as recognising deterioration, knowing when to seek help or understanding the possible long-term consequences.
For patients and families, sepsis is often characterised by uncertainty and sudden escalation. What begins as a seemingly manageable infection can rapidly become life-threatening.
And for survivors, the effects may continue well beyond hospital discharge. Physical weakness, cognitive impairment, psychological challenges and reduced independence can affect quality of life for months or years. Families can become an integral part of the recovery journey too, adapting their personal and working lives to support loved ones.
There is also a strong economic argument for reducing its impact.
But the costs extend beyond acute care. Lost productivity, ongoing healthcare needs, rehabilitation and social care all add to the wider burden.
Viewed through this lens, reducing the impact of sepsis is not only a patient safety priority. It is also an opportunity to create significant value for health and care systems and wider society.
The community as a frontline for recognising deterioration
If we are serious about improving outcomes, we need to look beyond what happens once somebody reaches hospital.
Many infections that lead to sepsis originate and progress in community settings.
A resident in a care home becomes less responsive than usual. A family member notices increasing confusion. Someone recovering from an infection begins deteriorating unexpectedly. A community nurse picks up subtle changes in a person’s condition.
These signs may not immediately be recognised as developing sepsis. But each represents a potential opportunity to intervene sooner.
That points to an important distinction. The challenge is not simply to identify sepsis earlier. It is to get better at recognising and responding to deterioration before somebody becomes critically unwell.
That means considering the role of primary care, community services, care homes, domiciliary care, mental health services, families and carers – and how effectively those different parts of the system work together.
As health and care services increasingly adopt neighbourhood and place-based models, there is an opportunity to strengthen the way deterioration is identified and acted upon across organisational boundaries.
Better pathways, not simply better products
When discussing innovation, it can be tempting to start with technology.
But technology alone will not transform sepsis outcomes.
The bigger opportunity is to design pathways that identify people’s needs earlier and enable timely, coordinated support – and then consider how innovation can make those pathways work better.
There are already promising possibilities.
Wearable technology, for example, is beginning to be integrated into pathways to support the management of deterioration in emergency departments. At a recent HIN and DigitalHealth.London Healthcare Challenge event, we also heard ambitions to connect these approaches more closely with remote monitoring in community settings.
Other opportunities include risk prediction and stratification tools, predictive analytics, digital assessment and escalation systems, new models of community care, and approaches that help patients, carers and professionals recognise deterioration sooner.
The principle running through all of these is important: innovation should enhance clinical judgement, not replace it.
The greatest value is likely to come not from individual technologies used in isolation, but when useful capabilities are combined with clinical expertise and embedded into well-designed care pathways.
Recovery is part of the pathway too
Looking beyond hospital also means looking at what happens afterwards.
While significant effort has understandably focused on recognising and treating sepsis, recovery remains one of the less developed parts of the pathway.
Many survivors continue to experience physical, cognitive and psychological effects that can affect their employment, independence and overall wellbeing.
There is scope to improve that experience through personalised follow-up, rehabilitation, digital tools and more integrated recovery pathways.
Supporting recovery more effectively is not simply beneficial for patients and families. It may also help reduce longer-term demand elsewhere in health and care.
It also raises a broader question about how we define success.
Traditionally, much of our focus has been on outcomes within acute care. A whole-pathway approach means looking more widely: at preventing severe infection, recognising deterioration earlier, enabling timely escalation and intervention, avoiding admissions where possible, and improving recovery and survivorship.
Seen in that way, sepsis becomes a powerful example of why prevention and community-based care matter.
Finding where innovation can make the biggest difference
This thinking sits at the heart of the National Innovation Exchange and Pipeline Development – Sepsis programme.
As part of this work, Health Innovation Networks and our partners are exploring how innovation can support the prevention, identification, escalation and management of deterioration within community settings.
Our aim is to identify promising approaches, understand the evidence behind them and assess their readiness for adoption within the NHS.
Through horizon scanning, evidence reviews and engagement with clinicians, patients, innovators and system leaders, the programme will help build a clearer picture of what works, where gaps remain and which innovations have the greatest potential to make a difference.
It may be helping a carer recognise that somebody is becoming unwell. Giving a community professional better information to inform a decision. Connecting services so that concerns are acted on more quickly. Or supporting somebody more effectively after they leave hospital.
Share what you’re learning with us
Are you trying to improve sepsis outcomes, or working on deterioration or care pathways outside hospital?
We want to hear from people across health and care who are tackling these challenges in primary care, community services, care homes, neighbourhood teams and other out-of-hospital settings.
If you have learning to share, are exploring new approaches, or want to find out more about our ongoing work through the National Innovation Exchange and Innovation Pipeline – Sepsis programme, please get in touch with us.
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