Implementation of a real-time computerized sepsis alert in nonintensive care unit patients*

Sawyer, Amber M; Deal, Eli N.; Labelle, Andrew; Witt, Chad; Thiel, Steven W.; Heard, Kevin M.; Reichley, Richard M.; Micek, Scott T.; Kollef, Marin H.

doi:10.1097/ccm.0b013e318205df85

Cited by 156 publications

(182 citation statements)

References 22 publications

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“…Our findings have important implications for inpatient sepsis screening, because a triggering rate of half of the ward population is operationally untenable and not feasible to implement. Patients who present with sepsis on the wards have a higher mortality rate than those who present to the emergency room (26), and there is increasing interest in the early identification and treatment of these patients (17). Our study demonstrates that the SIRS criteria are too nonspecific as the initial screening mechanism for ward patients, with almost 50% meeting two of the four criteria at least once during their stay.…”

Section: Original Articlementioning

confidence: 60%

“…First, many patients who develop sepsis are initially treated on the wards (14), and it has been shown that patients admitted to the ICU from the wards have a higher mortality rate than those admitted to the ICU from the emergency department (15,16). Second, many hospitals are now expanding their sepsis screening programs to the wards (17)(18)(19), and so information regarding the incidence and prognostic value of these criteria would inform these efforts. Finally, the evolution of different organ dysfunctions over time on the wards may impart important prognostic information for these patients.…”

mentioning

confidence: 99%

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Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

Churpek

Zadravecz

Winslow

et al. 2015

Am J Respir Crit Care Med

281

163

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Rationale: Tools that screen inpatients for sepsis use the systemic inflammatory response syndrome (SIRS) criteria and organ dysfunctions, but most studies of these criteria were performed in intensive care unit or emergency room populations.Objectives: To determine the incidence and prognostic value of SIRS and organ dysfunctions in a multicenter dataset of hospitalized ward patients.Methods: Hospitalized ward patients at five hospitals from November 2008 to January 2013 were included. SIRS and organ system dysfunctions were defined using 2001 International Consensus criteria. Patient characteristics and in-hospital mortality were compared among patients meeting two or more SIRS criteria and by the presence or absence of organ system dysfunction.Measurements and Main Results: A total of 269,951 patients were included in the study, after excluding 48 patients with missing discharge status. Forty-seven percent (n = 125,841) of the included patients met two or more SIRS criteria at least once during their ward stay. On ward admission, 39,105 (14.5%) patients met two or more SIRS criteria, and patients presenting with SIRS had higher inhospital mortality than those without SIRS (4.3% vs. 1.2%; P , 0.001). Fourteen percent of patients (n = 36,767) had at least one organ dysfunction at ward admission, and those presenting with organ dysfunction had increased mortality compared with those without organ dysfunction (5.3% vs. 1.1%; P , 0.001).Conclusions: Almost half of patients hospitalized on the wards developed SIRS at least once during their ward stay. Our findings suggest that screening ward patients using SIRS criteria for identifying those with sepsis would be impractical.

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Section: Original Articlementioning

confidence: 60%

mentioning

confidence: 99%

Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

Churpek

Zadravecz

Winslow

et al. 2015

Am J Respir Crit Care Med

281

163

View full text Add to dashboard Cite

show abstract

“…Opportunities for improvement in patient care exist with identification and management of low-and high-risk AKI patients. Automated clinical surveillance systems are effective for a variety of clinical conditions including the identification of sepsis (19), adverse drug reactions (20,21), and more recently, AKI (22,23). These surveillance systems have assisted with faster identification of events compared with usual care that has been shown to improve shortterm progression of AKI severity (22,24,25).…”

Section: Discussionmentioning

confidence: 99%

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Sileanu

Murugan

Lucko

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU).Design, setting, participants, & measurements A large, academic medical center database, with records from July 2000 through October 2008, was used and the authors identified a low-risk cohort as patients without cardiovascular and respiratory organ failures defined as not receiving vasopressor support or mechanical ventilation within the first 24 hours of ICU admission. AKI was defined using Kidney Disease Improving Global Outcomes criteria. The primary end points were moderate to severe AKI (stages 2-3) and risk-adjusted hospital mortality.Results Of 40,152 critically ill patients, 44.9% received neither vasopressors nor mechanical ventilation on ICU day 1. Stages 2-3 AKI occurred less frequently in the low-risk patients versus high-risk patients within 24 hours (14.3% versus 29.1%) and within 1 week (25.7% versus 51.7%) of ICU admission. Patients developing AKI in both risk groups had higher risk of death before hospital discharge. However, the adjusted odds of hospital mortality were greater (odds ratio, 2.99; 95% confidence interval, 2.62 to 3.41) when AKI occurred in low-risk patients compared with those with respiratory or cardiovascular failures (odds ratio, 1.19; 95% confidence interval, 1.09 to 1.3); interaction P,0.001.Conclusions Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk patients. Strategies aimed at preventing AKI should not exclude ICU patients without cardiovascular or respiratory organ failures.

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“…However, as predictive medicine improves, EHRs will become a dynamic tool that may actually improve patient care in real time. Although few studies have analyzed real-time data, studies that have are proven successful (23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

Goldstein¹,

Chang

Mitani³

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Sudden cardiac death is the most common cause of death among individuals undergoing hemodialysis. The epidemiology of sudden cardiac death has been well studied, and efforts are shifting to risk assessment. This study aimed to test whether assessment of acute changes during hemodialysis that are captured in electronic health records improved risk assessment. died on the day of or day after a dialysis session that was serving as a training or test data session, respectively. A reasonably strong predictor was derived using just predialysis information (concordance statistic=0.782), which showed modest but significant improvement after inclusion of postdialysis information (concordance statistic=0.799, P,0.001). However, risk prediction decreased the farther out that it was forecasted (up to 1 year), and postdialytic information became less important.Conclusion Subtle changes in the experience of hemodialysis aid in the assessment of sudden cardiac death and are captured by modern electronic health records. The collected data are better for the assessment of near-term risk as opposed to longer-term risk.

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Implementation of a real-time computerized sepsis alert in nonintensive care unit patients*

Abstract: The sepsis alert developed at Barnes-Jewish Hospital was shown to increase early therapeutic and diagnostic interventions among nonintensive care unit patients at risk for sepsis.

Cited by 156 publications

References 22 publications

Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

AKI in Low-Risk versus High-Risk Patients in Intensive Care

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

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