Development and Implementation of Sepsis Alert Systems

Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian; Herasevich, Vitaly

doi:10.1016/j.ccm.2016.01.004

Cited by 38 publications

(25 citation statements)

References 61 publications

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“…However, the heterogeneity of septic shock prevents adequate characterization of patients and may hinder subsequent clinical intervention(s). Sepsis and septic shock affect anywhere between 100 to 1000 per 100,000 person-years and 19 per 100,000 person-years depending on the cohort studied [3–6], with reported mortality rates ranging between 20 to 50% [7–11]. Moreover, the reported incidence is increasing, although this may be attributed to reporting bias in so-called claims-based databases, as data analysis on electronic health records cannot confirm this trend [12–15].…”

Section: Introductionmentioning

confidence: 99%

Cytokine removal in human septic shock: Where are we and where are we going?

Honoré

Hoste

Molnár

et al. 2019

Ann. Intensive Care

146

119

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Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been suggested as one such method, but these approaches, such as high-volume continuous haemofiltration or cytokine and/or endotoxin removal, have enjoyed little success to date. More recently, the use of sorbent technologies has attracted much attention. These adsorbers are highly effective at removing inflammatory mediators, in particular, cytokines, from the bloodstream. This narrative review is the executive summary of meetings held throughout the 6th International Fluid Academy Days in Antwerp, Belgium (Nov 23–25, 2017), focusing on the current understanding regarding the use of such adsorbers in humans with septic shock. We followed a modified Delphi approach involving a combination of evidence appraisal together with expert opinion in order to achieve recommendations for practice and, importantly, future research.

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Section: Introductionmentioning

confidence: 99%

Cytokine removal in human septic shock: Where are we and where are we going?

Honoré

Hoste

Molnár

et al. 2019

Ann. Intensive Care

146

119

View full text Add to dashboard Cite

show abstract

“…Similarly, more than 90% of febrile children in the ED meet vital sign criteria for SIRS ( 5 ), and ~12% of all ED children triggered an alert based on tachycardia alone ( 4 ). These data suggest that current sepsis screening tools identify too many at-risk children, leading to alert fatigue ( 18 ) and reluctance to use the tool.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Vital Sign Distribution Derived From a Multi-Centered Emergency Department Database

2018

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BackgroundWe hypothesized that current vital sign thresholds used in pediatric emergency department (ED) screening tools do not reflect observed vital signs in this population. We analyzed a large multi-centered database to develop heart rate (HR) and respiratory rate centile rankings and z-scores that could be incorporated into electronic health record ED screening tools and we compared our derived centiles to previously published centiles and Pediatric Advanced Life Support (PALS) vital sign thresholds.MethodsInitial HR and respiratory rate data entered into the Cerner™ electronic health record at 169 participating hospitals’ ED over 5 years (2009 through 2013) as part of routine care were analyzed. Analysis was restricted to non-admitted children (0 to <18 years). Centile curves and z-scores were developed using generalized additive models for location, scale, and shape. A split-sample validation using two-thirds of the sample was compared with the remaining one-third. Centile values were compared with results from previous studies and guidelines.ResultsHR and RR centiles and z-scores were determined from ~1.2 million records. Empirical 95th centiles for HR and respiratory rate were higher than previously published results and both deviated from PALS guideline recommendations.ConclusionHeart and respiratory rate centiles derived from a large real-world non-hospitalized ED pediatric population can inform the modification of electronic and paper-based screening tools to stratify children by the degree of deviation from normal for age rather than dichotomizing children into groups having “normal” versus “abnormal” vital signs. Furthermore, these centiles also may be useful in paper-based screening tools and bedside alarm limits for children in areas other than the ED and may establish improved alarm limits for bedside monitors.

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“…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 …”

mentioning

confidence: 99%

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

Long

Capan

Mascioli

et al. 2018

Critical Care Nurse

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Background Hospitals are increasingly turning to clinical decision support systems for sepsis, a life-threatening illness, to provide patient-specific assessments and recommendations to aid in evidence-based clinical decision-making. Lack of guidelines on how to present alerts has impeded optimization of alerts, specifically, effective ways to differentiate alerts while highlighting important pieces of information to create a universal standard for health care providers. Objective To gain insight into clinical decision support systems–based alerts, specifically targeting nursing interventions for sepsis, with a focus on behaviors associated with and perceptions of alerts, as well as visual preferences. Methods An interactive survey to display a novel user interface for clinical decision support systems for sepsis was developed and then administered to members of the nursing staff. Results A total of 43 nurses participated in 2 interactive survey sessions. Participants preferred alerts that were based on an established treatment protocol, were presented in a pop-up format, and addressed the patient’s clinical condition rather than regulatory guidelines. Conclusions The results can be used in future research to optimize electronic medical record alerting and clinical practice workflow to support the efficient, effective, and timely delivery of high-quality care to patients with sepsis. The research also may advance the knowledge base of what information health care providers want and need to improve the health and safety of their patients.

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Development and Implementation of Sepsis Alert Systems

Cited by 38 publications

References 61 publications

Cytokine removal in human septic shock: Where are we and where are we going?

Cytokine removal in human septic shock: Where are we and where are we going?

Pediatric Vital Sign Distribution Derived From a Multi-Centered Emergency Department Database

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

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