A national quality improvement initiative for reducing harm and death from sepsis in Wales

The Rapid Response to Acute Illness (RRAILS) Programme is a quality and service improvement initiative which is participated in by all Welsh healthcare organisations including the Welsh Ambulance Service Trust (WAST) and Velindre Cancer Centre. The aims of the programme were and are: Implementing the National Early Warning Score (NEWS) as standard in all clinical areas in all 18 acute hospitals. Quantifying the incidence of sepsis and acute deterioration in the non Critical Care setting. Improving reliability of systems for identification, escalation and treatment of sepsis. Demonstrably improving outcomes from sepsis and other causes of acute deterioration.

Clinical teams participated in learning sets at which they were trained in service improvement and human factors principles and then supported to implement 'bundles' of best evidence whilst measuring both processes and outcomes.

All organisations have implemented standardised tools and operating procedures including NEWS, sepsis screening tools, Patient Status at A Glance (PSAG) boards, sepsis response bags and an antibiotic formulary. All organisations have demonstrated improvements in the reliability of detection and escalation of acute deterioration whilst many have started to demonstrate local improvements in outcomes.

The collaborative learning set is an effective method for improving quality of sepsis care throughout a single healthcare economy.