Clinical Decision Support for Early Recognition of Sepsis

Abstract

Sepsis is an inflammatory response triggered by infection, with a high in-hospital mortality rate. Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes. One challenge clinicians face is identifying the inflammatory syndrome against the background of the patient’s infectious illness and comorbidities. An approach to this problem is implementation of computerized early warning tools for sepsis. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Data encompassed 6200 adult hospitalizations from 2012 through 2013. Of 13% patients screened-in, 51% were already suspected to have an infection when the system activated. This study focused on a patient cohort screened-in before infection was suspected; median time from arrival to CDS activation was 3.5 hours, and system activation to diagnostic collect was another 8.6 hours.

Evaluation of User-Interface Alert Displays for Clinical Decision Support Systems for Sepsis

“…11,13,18–23 However, these tools emphasize venue-centric, localized definitions of sepsis, a situation that, in addition to constantly changing definitions of and guidelines for treatment of sepsis, affects the tools’ diagnostic usefulness and broad adoption. 24 Because of the challenges of health information technology, current sepsis alerting systems include variability and availability of reliable electronic data, making monitoring of these alerts tedious and time-consuming. 22,23 …”

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

“…The digital sepsis alert is based on the St John Sepsis Algorithm developed by Cerner,[24] shown in Figure 1. The alert is an integrated part of the Electronic Health Record (EHR) and has a silent running mode.…”

Safe Use of Vasopressin and Angiotensin II for Patients with Circulatory Shock

“…In addition, numerous studies have demonstrated the use of the EMR for the rapid identification of patients with sepsis, the population in whom AVP and angiotensin II is most likely to be utilized and gain benefit. One report described the validation of a sepsis CDS alert using a cloud‐based computerized system that allowed for real‐time identification of patients with suspected sepsis . They observed that the sepsis CDS enabled providers to accelerate diagnostic and therapeutic interventions.…”

“…One report described the validation of a sepsis CDS alert using a cloudbased computerized system that allowed for realtime identification of patients with suspected sepsis. 65 They observed that the sepsis CDS enabled providers to accelerate diagnostic and therapeutic interventions. Similarly, another study described the development of an early warning and response system that triggered a rapid response coordinator when patients met the predefined laboratory and vital sign abnormalities.…”