Abstract
Objective: To improve the timely diagnosis and treatment of sepsis many institutions implemented automated sepsis alerts. Poor specificity, time delays, and a lack of actionable information lead to limited adoption by bedside clinicians and no change in practice or clinical outcomes. We aimed to compare sepsis care compliance before and after a multi-year implementation of a sepsis surveillance coupled with decision support in a tertiary care center. Design: Single center before and after study. Setting: Large academic Medical Intensive Care Unit (MICU) and Emergency Department (ED). Population: Patients 18 years of age or older admitted to *** Hospital MICU and ED from 09/4/2011 to 05/01/2018 with severe sepsis or septic shock. Interventions: Electronic medical record-based sepsis surveillance system augmented by clinical decision support and completion feedback. Measurements and main results: There were 1950 patients admitted to the MICU with the diagnosis of severe sepsis or septic shock during the study period. The baseline characteristics were similar before (N = 854) and after (N = 1096) implementation of sepsis surveillance. The performance of the alert was modest with a sensitivity of 79.9%, specificity of 76.9%, positive predictive value (PPV) 27.9%, and negative predictive value (NPV) 97.2%. There were 3424 unique alerts and 1131 confirmed sepsis patients after the sniffer implementation. During the study period average care bundle compliance was higher; however after taking into account improvements in compliance leading up to the intervention, there was no association between intervention and improved care bundle compliance (Odds ratio: 1.16; 95% CI: 0.71 to 1.89; p-value 0.554). Similarly, the intervention was not associated with improvement in hospital mortality (Odds ratio: 1.55; 95% CI: 0.95 to 2.52; p-value: 0.078). Conclusions: A sepsis surveillance system incorporating decision support or completion feedback was not associated with improved sepsis care and patient outcomes.
Original language | English (US) |
---|---|
Pages (from-to) | 378-383 |
Number of pages | 6 |
Journal | American Journal of Emergency Medicine |
Volume | 51 |
DOIs | |
State | Published - Jan 2022 |
Keywords
- Data display
- Informatics
- Information technology
- Sepsis
- Shock
- Surveillance
ASJC Scopus subject areas
- Emergency Medicine