An electronic warning system helps reduce the time to diagnosis of sepsis

Westphal, Glauco Adrieno; Pereira, Aline Braz; Fachin, Silvia Maria; Sperotto, Geonice; Gonçalves, Maurício; Albino, Lucimeri; Bittencourt, Rodolfo; Franzini, Vanessa de Rossi; Köenig, Álvaro

doi:10.5935/0103-507x.20180059

Cited by 22 publications

(15 citation statements)

References 54 publications

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“… 10 , 12 , 13 Some of these systems were created for use in the inpatient ward, 14 , 15 intensive care unit (ICU), 16 , 17 and emergency department (ED), 18 , 19 and some stretch across settings within a healthcare system. 20 , 21 One study demonstrated that over 75% of sepsis hospitalizations presented in the ED, warranting a focused study of this population. 22 …”

Section: Introductionmentioning

confidence: 99%

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact

Hwang

Bond

Powell

2020

WestJEM

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Introduction For early detection of sepsis, automated systems within the electronic health record have evolved to alert emergency department (ED) personnel to the possibility of sepsis, and in some cases link them to suggested care pathways. We conducted a systematic review of automated sepsis-alert detection systems in the ED. Methods We searched multiple health literature databases from the earliest available dates to August 2018. Articles were screened based on abstract, again via manuscript, and further narrowed with set inclusion criteria: 1) adult patients in the ED diagnosed with sepsis, severe sepsis, or septic shock; 2) an electronic system that alerts a healthcare provider of sepsis in real or near-real time; and 3) measures of diagnostic accuracy or quality of sepsis alerts. The final, detailed review was guided by QUADAS-2 and GRADE criteria. We tracked all articles using an online tool (Covidence), and the review was registered with PROSPERO registry of reviews. A two-author consensus was reached at the article choice stage and final review stage. Due to the variation in alert criteria and methods of sepsis diagnosis confirmation, the data were not combined for meta-analysis. Results We screened 693 articles by title and abstract and 20 by full text; we then selected 10 for the study. The articles were published between 2009–2018. Two studies had algorithm-based alert systems, while eight had rule-based alert systems. All systems used different criteria based on systemic inflammatory response syndrome (SIRS) to define sepsis. Sensitivities ranged from 10–100%, specificities from 78–99%, and positive predictive value from 5.8–54%. Negative predictive value was consistently high at 99–100%. Studies showed some evidence for improved process-of-care markers, including improved time to antibiotics. Length of stay improved in two studies. One low quality study showed improved mortality. Conclusion The limited evidence available suggests that sepsis alerts in the ED setting can be set to high sensitivity. No high-quality studies showed a difference in mortality, but evidence exists for improvements in process of care. Significant further work is needed to understand the consequences of alert fatigue and sensitivity set points.

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Section: Introductionmentioning

confidence: 99%

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact

Hwang

Bond

Powell

2020

WestJEM

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“…Studies (24,27) show that the patient with sepsis has altered physiological parameters 8 hours before, and their survival depends on the ability of the nurse to recognize these changes. It is essential to train the nursing teams, since the nurse is the professional who has the most contact with the patient Therefore, nurses must be able to promptly identify these alterations and act in rapid, safe and well-founded manner.…”

Section: Discussionmentioning

confidence: 99%

The role of the nurse in caring for the critical patient with sepsis

et al. 2020

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ABSTRACT Objectives: to know the nursing interventions in the identification, prevention and control of sepsis in critical patients. Methods: integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample. Results: nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis. Final Considerations: the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.

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“…Further research should also seek to answer several other important questions such as the optimal type of sepsis alert, which team members should be alerted, and at what frequency should they be alerted. A recent observational cohort study reviewing successive improvements over a 10-year period found that reviewed sepsis alerts were sent to a telephonist and alerts were sent to a nurse's mobile phone [42]. They found that time to antibiotics was reduced to 1 hour (55 min to 1 hour 30 min) when the alert was sent to the telephonist and to 45 min (30 min to 1 hour) when the alert was sent directly to the nurse's mobile phone (P=.02) [42].…”

Section: Discussionmentioning

confidence: 99%

Digital Alerting and Outcomes in Patients With Sepsis: Systematic Review and Meta-Analysis

et al. 2019

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Background The diagnosis and management of sepsis remain a global health care challenge. Digital technologies have the potential to improve sepsis care. Objective The aim of this paper was to systematically review the evidence on the impact of digital alerting systems on sepsis related outcomes. Methods The following databases were searched for studies published from April 1964 to February 12, 2019, with no language restriction: EMBASE, MEDLINE, HMIC, PsycINFO, and Cochrane. All full-text reports of studies identified as potentially eligible after title and abstract reviews were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand searched for other studies. Only studies with clear pre- and postalerting phases were included. Primary outcomes were hospital length of stay (LOS) and intensive care LOS, whereas secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials, and commentaries were excluded. All other trial designs were included. A qualitative assessment and meta-analysis were performed. Results This review identified 72 full-text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital LOS, 12 reviewed mortality outcomes, 5 studies explored time to antibiotics, and 5 studies investigated intensive care unit (ICU) LOS. Both quantitative and qualitative assessments of the studies were performed. There was evidence of a significant benefit of digital alerting in hospital LOS, which reduced by 1.31 days (P=.014), and ICU LOS, which reduced by 0.766 days (P=.007). There was no significant association between digital alerts and mortality (mean decrease 11.4%; P=.77) or time to antibiotics (mean decrease 126 min; P=.13). Conclusions This review highlights that digital alerts can considerably reduce hospital and ICU stay for patients with sepsis. Further studies including randomized controlled trials are necessary to confirm these findings and identify the choice of alerting system according to the patient status and pathological cohort.

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An electronic warning system helps reduce the time to diagnosis of sepsis

Cited by 22 publications

References 54 publications

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact

Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact

The role of the nurse in caring for the critical patient with sepsis

Digital Alerting and Outcomes in Patients With Sepsis: Systematic Review and Meta-Analysis

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