Development, implementation, and impact of an automated early warning and response system for sepsis

Abstract

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.

Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization

“…The results showed that the total average cost was US$ 9,632.00 (R$ 21,566.00) per patient, www.ee.usp.br/reeusp Sepsis in a university hospital: a prospective study for the cost analysis of patients' hospitalization and the average daily rate cost was significantly higher for non-survivors (11) . The presented data warn the institutions about the need for investment in professional training for the early diagnosis and implementation of treatment at the appropriate time, in order to be more effective and contribute with patients' recovery, reducing the misdirection of investments that culminate in death (20) . The creation of a team for research and control of sepsis using management protocols for early diagnosis and appropriate treatment has proven an effective strategy to improve health indicators, such as reducing the chances of evolving to death by 30%, and reduction in days of hospital stay, which may reflect in reduction of hospital costs (20) .…”

“…The presented data warn the institutions about the need for investment in professional training for the early diagnosis and implementation of treatment at the appropriate time, in order to be more effective and contribute with patients' recovery, reducing the misdirection of investments that culminate in death (20) . The creation of a team for research and control of sepsis using management protocols for early diagnosis and appropriate treatment has proven an effective strategy to improve health indicators, such as reducing the chances of evolving to death by 30%, and reduction in days of hospital stay, which may reflect in reduction of hospital costs (20) . Note the limitation of this study having been performed in a teaching hospital, where many factors influence costs in comparison to other health institutions.…”

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

“…AeSAS employs two or more SIRS criteria as alert threshold (67)(68)(69)(70). Other studies use additional threshold such as SBP (71), and a lactic acid concentration >2 mmol/L (72,73). Two studies employed recursive partitioning tree analysis involving a variety of variables such as shock index, mean arterial blood pressure, international normalized ratio (INR), white blood cell (WBC) count, absolute neutrophil count, bilirubin, albumin, hemoglobin and sodium (74,75).…”

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

“…Tools that reliably detect early community-acquired sepsis are warranted and are the topic of intensive research. Meanwhile, there are studies focusing on early recognition of sepsis in hospitalized patients (110)(111)(112). As mentioned before, this patient population may be identified more easily and thus become more amenable for straightforward EGDT.…”