Implementation and evaluation of sepsis surveillance and decision support in medical ICU and emergency department
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Published on: January 16, 2019
Kirill Lipatov1, Craig E Daniels1, John G Park1
1Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Objective:
To improve the timely diagnosis and treatment of sepsis many institutions implemented automated sepsis alerts. Poor specificity, time delays, and a lack of actionable information lead to limited adoption by bedside clinicians and no change in practice or clinical outcomes. We aimed to compare sepsis care compliance before and after a multi-year implementation of a sepsis surveillance coupled with decision support in a tertiary care center.
Design:
Single center before and after study.
Setting:
Large academic Medical Intensive Care Unit (MICU) and Emergency Department (ED).
Population:
Patients 18 years of age or older admitted to *** Hospital MICU and ED from 09/4/2011 to 05/01/2018 with severe sepsis or septic shock.
Interventions:
Electronic medical record-based sepsis surveillance system augmented by clinical decision support and completion feedback.
Measurements And Main Results:
There were 1950 patients admitted to the MICU with the diagnosis of severe sepsis or septic shock during the study period. The baseline characteristics were similar before (N = 854) and after (N = 1096) implementation of sepsis surveillance. The performance of the alert was modest with a sensitivity of 79.9%, specificity of 76.9%, positive predictive value (PPV) 27.9%, and negative predictive value (NPV) 97.2%. There were 3424 unique alerts and 1131 confirmed sepsis patients after the sniffer implementation. During the study period average care bundle compliance was higher; however after taking into account improvements in compliance leading up to the intervention, there was no association between intervention and improved care bundle compliance (Odds ratio: 1.16; 95% CI: 0.71 to 1.89; p-value 0.554). Similarly, the intervention was not associated with improvement in hospital mortality (Odds ratio: 1.55; 95% CI: 0.95 to 2.52; p-value: 0.078).
Conclusions:
A sepsis surveillance system incorporating decision support or completion feedback was not associated with improved sepsis care and patient outcomes.
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