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Early-Onset Sepsis Risk Calculator Integration Into an Electronic Health Record in the Nursery
Carole H Stipelman1, Elizabeth R Smith2, Margarita Diaz-Ochu2
1Division of General Pediatrics, Department of Pediatrics, carole.stipelman@hsc.utah.edu.
Insights
Implementing an electronic health record (EHR)-driven early-onset sepsis (EOS) risk calculator improved tool use in newborns. This quality improvement initiative successfully reduced antibiotic prescriptions for infants at low risk for sepsis without adverse outcomes.
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Health Informatics
Background:
- Early-onset sepsis (EOS) poses a significant risk to newborns, necessitating careful evaluation and treatment.
- Existing risk calculators aim to guide clinical decisions and reduce unnecessary antibiotic use.
- Electronic health record (EHR) integration offers a pathway to enhance the adoption and effectiveness of these tools.
Purpose of the Study:
- To implement and assess an EHR-driven quality improvement intervention to increase the use of an EOS risk calculator in a newborn nursery.
- To reduce the incidence of antibiotic treatment for infants identified as low risk for sepsis.
- To evaluate the impact of the intervention on antibiotic prescribing patterns and patient safety.
Main Methods:
- A two-phase EHR-driven intervention was designed, incorporating calculator fields, user education, and structured bedside rounds.
- Phase 1 involved external calculator fields with non-automatic access, while Phase 2 integrated discrete data entry with a web hyperlink.
- Statistical process control and interrupted time series analysis were used to monitor calculator use and antibiotic orders.
Main Results:
- Calculator use increased from a mean of 59% in Phase 1 to 85% in Phase 2, with reduced variability.
- Antibiotic order frequency decreased significantly from 7% pre-intervention to 1% during the final 6 months of Phase 2 (P < .001).
- The intervention demonstrated successful adoption and a marked reduction in antibiotic prescribing.
Conclusions:
- An EHR-driven quality improvement intervention effectively increased the utilization of the EOS risk calculator.
- The intervention led to a significant reduction in antibiotic orders for newborns without an increase in adverse events.
- This approach demonstrates the potential for technology integration in optimizing neonatal care and antimicrobial stewardship.
Background And Objectives:
An early-onset sepsis (EOS) risk calculator tool to guide evaluation and treatment of infants at risk for sepsis has reduced antibiotic use without increased adverse outcomes. We performed an electronic health record (EHR)-driven quality improvement intervention to increase calculator use for infants admitted to a newborn nursery and reduce antibiotic treatment of infants at low risk for sepsis.
Methods:
This 2-phase intervention included programming (1) an EHR form containing calculator fields that were external to the infant's admission note, with nonautomatic access to the calculator, education for end-users, and reviewing risk scores in structured bedside rounds and (2) discrete data entry elements into the EHR admission form with a hyperlink to the calculator Web site. We used statistical process control to assess weekly entry of risk scores and antibiotic orders and interrupted time series to assess trend of antibiotic orders.
Results:
During phase 1 (duration, 14 months), a mean 59% of infants had EOS calculator scores entered. There was wide variability around the mean, with frequent crossing of weekly means beyond the 3σ control lines, indicating special-cause variation. During phase 2 (duration, 2 years), mean frequency of EOS calculator use increased to 85% of infants, and variability around the mean was within the 3σ control lines. The frequency of antibiotic orders decreased from preintervention (7%) to the final 6 months of phase 2 (1%, P < .001).
Conclusions:
An EHR-driven quality improvement intervention increased EOS calculator use and reduced antibiotic orders, with no increase in adverse events.
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