The Use of an Early Alert System to Improve Compliance with Sepsis Bundles and to Assess Impact on Mortality

Abstract

Introduction. Diagnostic and therapeutic guidelines, organized as sepsis bundles, have been shown to improve mortality, but timely and consistent implementation of these can be challenging. Our study examined the use of a screening tool and an early alert system to improve bundle compliance and mortality. Methods. A screening tool was used to identify patients with severe sepsis or septic shock and an overhead alert system known as Code SMART (Sepsis Management Alert Response Team) was activated at the physician's discretion. Data was collected for 6 months and compliance with bundle completion and mortality were compared between the Code SMART and non-Code SMART groups. Results. Fifty eight patients were enrolled −34 Code SMART and 24 non-Code SMART. The Code SMART group achieved greater compliance with timely antibiotic administration (P < 0.001), lactate draw (P < 0.001), and steroid use (P = 0.02). Raw survival and survival adjusted for age, leucopenia, and severity of illness scores, were greater in the Code SMART group (P < 0.05, P = 0.03, and P = 0.01). Conclusions. A screening tool and an alert system can improve compliance with sepsis bundle elements and improve survival from severe sepsis and septic shock.

Triage sepsis alert and sepsis protocol lower times to fluids and antibiotics in the ED

“…Sepsis screening and alert systems have been studied in both the ED and the intensive care unit, with improvements in early identification of sepsis and the initiation of therapy [20–24]. Computer alerts have also been studied in the context of sepsis, with improved compliance in terms of lactate testing [25].…”

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

“…Screening tools, including paper-based algorithms, protocols, and computerized sepsis CDS systems, have been used extensively and are relatively effective in the intensive care unit, 11–13 the emergency department, 14,15 and medical and surgical units. 16–18 Evidence-based CDS solutions currently exist; these are moderately successful in predictive accuracy, improved communication, and appropriate therapeutic and diagnostic interventions.…”

“…16–18 Evidence-based CDS solutions currently exist; these are moderately successful in predictive accuracy, improved communication, and appropriate therapeutic and diagnostic interventions. 11,13,18–23 However, these tools emphasize venue-centric, localized definitions of sepsis, a situation that, in addition to constantly changing definitions of and guidelines for treatment of sepsis, affects the tools’ diagnostic usefulness and broad adoption. 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.…”

Exclusive bed for thrombolysis. A simple measure that allows 85% of ischemic stroke patients to be treated in the first hour

“…The relation between reduction in time to treatment and better outcomes had been previously demonstrated in other diseases as myocardial infarction, trauma and sepsis 11,12,13,14 . In the last decade this was also considered in stroke, but only 26% of patients have the opportunity to receive IVT in the first hour after arrival 2 .…”