A Computerized Alert Screening for Severe Sepsis in Emergency Department Patients Increases Lactate Testing but does...

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Clinical Informatics

Background:

• Sepsis diagnosis in the emergency department (ED) relies on timely identification and testing.
• Systemic inflammatory response syndrome (SIRS) criteria, combined with clinical suspicion, are used to identify potential sepsis cases.
• Lactate testing is a crucial biomarker for assessing sepsis severity and guiding treatment.

Purpose of the Study:

• To evaluate the effectiveness of a computer-generated alert system in increasing lactate testing for ED sepsis patients.
• To assess the impact of the alert on identifying admitted sepsis patients with elevated lactate levels (≥4.0 mmol/L).
• To determine if the alert system influenced in-patient mortality rates among sepsis patients.

Main Methods:

• A 6-month pre-alert phase was followed by the implementation of a computer alert system.
• The alert system identified patients meeting ≥2 SIRS criteria and recommended lactate testing if infection was suspected.
• Data on lactate testing and patient outcomes were collected electronically for 6 months before and after alert implementation.

Main Results:

• Overall lactate testing in septic ED patients increased from 5.2% to 12.7% (p<0.001) after alert implementation.
• For admitted sepsis patients, lactate testing rose from 15.3% to 34.2% (p<0.001).
• A significant increase was observed in identifying admitted patients with lactate levels ≥4.0 mmol/L (1.9% absolute increase, p=0.05), while mortality showed a non-significant decrease (0.5%).

Conclusions:

• The computer alert system effectively enhanced lactate testing rates in the ED for sepsis patients.
• The alert system improved the identification of admitted sepsis patients with elevated lactate levels.
• In-patient mortality for sepsis patients did not change significantly following the implementation of the alert system.