The impact of an electronic medical record surveillance program on outcomes for patients with sepsis

McRee, Laura; Thanavaro, Joanne; Moore, Kristin J.; Goldsmith, M. F.; Pasvogel, Alice

doi:10.1016/j.hrtlng.2014.05.009

Cited by 35 publications

(37 citation statements)

References 16 publications

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“…The most commonly defined threshold was the presence of 2 or more systemic inflammatory response syndrome (SIRS) criteria. 10, 13, 17, 18 …”

Section: Resultsmentioning

confidence: 99%

“…19 Furthermore, if the sepsis alert was activated, two studies suggested specific clinical management decisions 14, 17 two studies left clinical management decisions solely to the discretion of the treating provider, 10, 19 and one study assisted the diagnosis of sepsis by prompting nurses to complete a second manual sepsis risk evaluation. 18 …”

Section: Resultsmentioning

confidence: 99%

“…10 Furthermore, three studies did not perform intention-to-treat analyses, rather, included only patients who triggered the alert and also had provider suspected or confirmed sepsis, 14, 17 or had a discharge diagnosis for sepsis. 18 …”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review

Makam

Nguyen

Auerbach

2015

Journal of Hospital Medicine

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Background Although timely treatment of sepsis improves outcomes, delays in administering evidence-based therapies are common. Purpose To determine whether automated real-time electronic sepsis alerts can: 1) accurately identify sepsis, and 2) improve process measures and outcomes. Data Sources We systematically searched MEDLINE, Embase, The Cochrane Library, and CINAHL from database inception through June 27, 2014. Study Selection Included studies that empirically evaluated one or both of the prespecified objectives. Data Extraction Two independent reviewers extracted data and assessed the risk of bias. Diagnostic accuracy of sepsis identification was measured by sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LR). Effectiveness was assessed by changes in sepsis care process measures and outcomes. Data Synthesis Of 1,293 citations, 8 studies met inclusion criteria, 5 for the identification of sepsis (n=35,423) and 5 for the effectiveness of sepsis alerts (n=6,894). Though definition of sepsis alert thresholds varied, most included systemic inflammatory response syndrome criteria ± evidence of shock. Diagnostic accuracy varied greatly, with PPV ranging from 20.5-53.8%, NPV 76.5-99.7%; LR+ 1.2-145.8; and LR- 0.06-0.86. There was modest evidence for improvement in process measures (i.e., antibiotic escalation), but only among patients in non-critical care settings; there were no corresponding improvements in mortality or length of stay. Minimal data were reported on potential harms due to false positive alerts. Conclusions Automated sepsis alerts derived from electronic health data may improve care processes but tend to have poor positive predictive value and do not improve mortality or length of stay.

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“…The most commonly defined threshold was the presence of 2 or more systemic inflammatory response syndrome (SIRS) criteria. 10, 13, 17, 18 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review

Makam

Nguyen

Auerbach

2015

Journal of Hospital Medicine

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“…Advances in electronic medical system technology and sophisticated machine learning techniques will "upgrade" prediction models making them more accurate and individualized (64)(65)(66). 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).…”

Section: Biomarkers and Screening Tools For Early Recognition Of Sepsismentioning

confidence: 99%

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

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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“…Two RCTs failed to show a beneficial effect of such alert systems (114,118). In contrast, a before-after study showed that applying an alert system resulted in a decreased mortality (117). Time to completion of the resuscitation bundle was not influenced by the use of an electronic alert system (118).…”

Section: The Importance Of Early Recognition Of Sepsismentioning

confidence: 98%

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

et al. 2017

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Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

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The impact of an electronic medical record surveillance program on outcomes for patients with sepsis

Cited by 35 publications

References 16 publications

Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review

Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review

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

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

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