Septic shock electronic surveillance

In a 2013 Healthcare Cost and Utilization Project Statistical Brief by the US Agency for Healthcare Research and Quality, septicemia was ranked as the #1 most expensive national inpatient hospital cost. This ranking comes in spite of substantial advances in the clinical management of sepsis over the past 15 years. While adherence with internationally established sepsis management protocols have demonstrated reduction in mortality and hospital/ICU length of stay, compliance with these protocols remains poor. Contributing factors may be delay in sepsis recognition and protocol implementation. A solution to this barrier is an automated sepsis detection and alert system embedded in the electronic medical record (EMR). In 2013, "alarm hazards" (e.g., excessive alarms, missed alarms, delayed alarms, etc.) was ranked as the #1 health technology hazard by the ECRI (Emergency Care Research Institute). Thus, sepsis surveillance systems must be developed and implemented in the context of alert fatigue, interruption, human error, and information overload. This chapter will describe essential elements in the electronic surveillance system development and implementation processes. Readers will learn about the critical elements of a septic shock detection algorithm and the data needed for each stage of sepsis management, such as early sepsis identification, notification of the clinicians, and tracking treatment processes. The chapter will describe the electronic components for this systems-level control of compliance with internationally established sepsis management protocols. A well-designed severe sepsis surveillance system has the potential to improve protocol compliance and patient outcomes, while reducing healthcare costs.