Background Early recognition and timely intervention significantly reduce sepsis-related mortality. Objective Describe the development, implementation and impact of an Early Warning and Response System (EWRS) for Sepsis. Design After tool derivation and validation, a pre/post study with multivariable adjustment measured impact. Setting Urban academic healthcare system Patients Adult non-ICU patients admitted to acute inpatient units from: 10/01–10/31/2011 for tool derivation, 06/06–07/05/2012 for tool validation, and 06/06–09/04/2012 and 06/06–09/04/2013 for the pre/post analysis. Intervention An EWRS in our electronic health record monitored laboratory values and vital signs in real time. If a patient had >= 4 predefined abnormalities at any one time, the provider, nurse, and rapid response coordinator were notified and performed an immediate bedside patient evaluation. Measurements Screen positive rates, test characteristics, predictive values and likelihood ratios; system utilization; and resulting changes in processes and outcomes. Results The tool’s screen positive, sensitivity, specificity, and positive and negative predictive values and likelihood ratios for our composite of intensive care unit (ICU) transfer, rapid response team call or death in the derivation cohort was 6%, 16%, 97%, 26%, 94%, 5.3 and 0.9, respectively. Validation values were similar. The EWRS resulted in a statistically significant increase in early sepsis care, ICU transfer, and sepsis documentation, and decreased sepsis mortality and increased discharge to home, although neither of these latter two findings reached statistical significance. Conclusions An automated prediction tool identified at risk patients and prompted a bedside evaluation resulting in more timely sepsis care, improved documentation, and a suggestion of reduced mortality.

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A minority of responders perceived the EWRS to be useful, likely related to the perception that most patients identified were stable. However, management was altered half the time after an alert. These results suggest further improvements to the system are needed to enhance clinician perception of the system's utility.

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Hairy cell leukemia has been described as chiefly a disease of the middle‐aged. A patient is reported in whom hairy cell leukemia developed at age 90, the oldest age recorded for onset of the disease. An estimation of age‐specific incidence rates revealed no major difference in incidences between the middle‐aged and the elderly populations.