Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting

Gibbs, Karen DiValerio; Shi, Yan; Sanders, Nicole; Bodnar, Anthony; Brown, Terri; Shah, Mona D.; Hess, Lauren M

doi:10.1055/s-0041-1730027

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…It is likely that the timely improvement in initial sepsis management with fluid and antibiotics, which was mediated by the sepsis EAS implementation, was associated with a reduction in mortality and LOS in PICU in our study. Similar findings were reported in a pediatric acute care setting where an analysis of the pre- and post-EAS implementation groups showed a reduction in both the 3-day sepsis-attributable mortality (2.53 vs. 0%] and 30-day mortality (3.8 vs. 1.3%) 30 . In adults, similar improvements in mortality and LOS outcomes have been associated with an EAS integrated with a multifaceted identification and intervention approach 3 , 15 .…”

Section: Discussionsupporting

confidence: 84%

“…The need for automated, effective, and timely screening tools for sepsis screening triggered further investment and investigations aimed at integrating health informatics and data analysis models 23,24 . The growing interest in machine learning and big data analysis fueled this innovative approach, which resulted in the development of automated decisions-aiding models and electronic alerts for potential sepsis cases 3,13,23,[25][26][27][28][29][30][31][32][33][34][35] .…”

Section: Discussionmentioning

confidence: 99%

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Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

Alturki

Al‐Eyadhy

Alfayez

et al. 2022

Sci Rep

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This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the “zero time”, early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

Alturki

Al‐Eyadhy

Alfayez

et al. 2022

Sci Rep

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“…[22][23][24][25] Research evaluating the effect of CDSS on provider practices have had mixed findings. [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Studies on CDSS tools have shown interventions both successfully changing provider behavior 26,27,[30][31][32][35][36][37][38][39] and having no impact on provider practice. 28,34 Previous research reported high levels of interest in PrEP-specific CDSS support among PrEP-inexperienced providers and found that a CDSS would have the greatest impact on knowledge and practice among providers without PrEP experience.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Usability and Utility of Human Immunodeficiency Virus Pre-exposure Prophylaxis Clinical Decision Support to Increase Knowledge and Pre-exposure Prophylaxis Initiations among Pediatric Providers

et al. 2022

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OBJECTIVES: An effective clinical decision support system (CDSS) may address the current provider training barrier to offering pre-exposure prophylaxis (PrEP) to youth at risk for human immunodeficiency virus (HIV) infection. This study evaluated change in provider knowledge and likelihood to initiate PrEP after exposure to a PrEP CDSS. A secondary objective explored perceived provider utility of the CDSS and suggestions for improving CDSS effectiveness. METHODS: This was a prospective study using survey responses from a convenience sample of pediatric providers who launched the interruptive PrEP CDSS when ordering an HIV test. McNemar’s test evaluated change in provider PrEP knowledge and likelihood to initiate PrEP. Qualitative responses on CDSS utility and suggested improvements were analyzed using Framework Analysis and were connected to quantitative analysis elements using the merge approach. RESULTS: Of the 73 invited providers, 43 had available outcome data and were included in the analysis. Prior to using the CDSS, 86% of participants had never prescribed PrEP. Compared to before CDSS exposure, there were significant increases in the proportion of providers who were knowledgeable about PrEP (p=0.0001), likely to prescribe PrEP (p<0.0001), and likely to refer their patient for PrEP (p<0.0001). Suggestions for improving the CDSS included alternative “triggers” for the CDSS earlier in visit workflows, having a non-interruptive CDSS, additional provider educational materials, access to patient-facing PrEP materials, and additional CDSS support for adolescent confidentiality and navigating financial implications of PrEP. CONCLUSIONS: Our findings suggest that an interruptive PrEP CDSS attached to HIV test orders can be an effective tool to increase knowledge and likelihood to initiate PrEP among pediatric providers. Continual improvement of the PrEP CDSS based on provider feedback is required to optimize usability, effectiveness, and adoption. A highly usable PrEP CDSS may be a powerful tool to close the gap in youth PrEP access and uptake.

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“…(2) Diagnostic criteria The diagnostic criteria for the TCM evidence of sepsis [7][8] are shown in Table 1.…”

Section: Study Populationmentioning

confidence: 99%

Chinese Medicine for Inflammatory Coagulation in Sepsis

2022

IJWM

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With the improvement of medical technology and level, more and more research on sepsis malefactors, the diagnosis and treatment of the disease are now more accurate and perfect with the gradual deepening of people's understanding of the disease, Western medicine has its own standards and norms of treatment, but also has its limitations and shortcomings, therefore, the search for new treatment methods is imperative, Chinese medicine as the traditional medicine of the motherland, in the process of inheritance of continuous innovation As a traditional medicine of the motherland, TCM is constantly innovating in the process of transmission, giving TCM an understanding of new diseases and proposing treatment options. The main objective of this paper is to analyse research related to the treatment of inflammatory coagulation caused by sepsis in Chinese medicine. It is found that the early stage of sepsis is characterised by more evidence of solid heat, which should be treated from the perspective of clearing heat and detoxifying the blood, cooling the blood and nourishing the yin, so as to interrupt the disease in a timely manner and avoid the emergence of severe symptoms of sepsis such as deficiency and decompensation. The study of TCM theory has provided new ideas and methods to be tried for the clinical adjunctive treatment of sepsis in TCM. From time to time, clinicians, especially TCM clinicians, use herbs, herbal injections or TCM external treatments as adjuncts in the treatment of sepsis. With the gradual development of basic and clinical applications of TCM in the treatment of sepsis, TCM has become more and more effective in improving coagulation disorders and coping with inflammatory reactions.

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Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting

Cited by 9 publications

References 20 publications

Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

Usability and Utility of Human Immunodeficiency Virus Pre-exposure Prophylaxis Clinical Decision Support to Increase Knowledge and Pre-exposure Prophylaxis Initiations among Pediatric Providers

Chinese Medicine for Inflammatory Coagulation in Sepsis

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