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Early Identification of Severe Sepsis in Pediatric Patients Using an Electronic Alert System
Uchechi Oddiri1, Grace Propper2, Patricia Brill2
1Division of Pediatric Critical Care.
Insights
Automated severe sepsis alerts significantly improved treatment compliance in pediatric patients. This electronic alert system enhanced early recognition and management, leading to better patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Clinical quality improvement
Background:
- Prompt recognition and treatment of severe sepsis are crucial for improving patient outcomes.
- Electronic medical record (EMR) systems can be leveraged to develop automated alerts for severe sepsis.
- Standardized treatment bundles are essential for effective sepsis management.
Purpose of the Study:
- To develop and implement automated severe sepsis alerts within the EMR system.
- To improve the compliance rate of the 1-hour severe sepsis treatment bundle in pediatric patients.
- To enhance the rapid identification and management of severe sepsis in emergency departments and inpatient units.
Main Methods:
- Developed electronic interruptive alerts based on the 2005 International Pediatric Sepsis Consensus definitions.
- Implemented a biphasic alert system: a nurse-targeted (NT) alert for systemic inflammatory response syndrome and a physician-targeted (PT) alert for organ dysfunction.
- Required bedside nurse response to the NT alert and implemented the PT alert for clinician paging.
Main Results:
- Baseline severe sepsis treatment bundle compliance was 37%.
- Bundle compliance increased to 69% after implementing the NT and PT alerts (P = .006).
- Physician-targeted alert response compliance improved from 67% to 91%.
Conclusions:
- Automated, interruptive severe sepsis screening alerts are valuable tools for prompt recognition and treatment.
- The biphasic alert system effectively facilitated multidisciplinary collaboration in early sepsis diagnosis and management.
- This electronic intervention demonstrated a statistically significant improvement in severe sepsis treatment bundle compliance.
Introduction:
Prompt sepsis recognition and the initiation of standardized treatment bundles lead to improved outcomes. We developed automated severe sepsis alerts through the electronic medical record and paging system to aid clinicians in rapidly identifying pediatric patients with severe sepsis in our emergency department and inpatient units. Our Specific, Measurable, Applicable, Realistic, Timely aim was to improve 1-hour severe sepsis treatment bundle compliance to 60% with these electronic interruptive alerts.
Methods:
We developed the alert's criteria based on the 2005 International Pediatric Sepsis Consensus definitions. We performed 2 interventions: requiring the bedside nurse to answer the already implemented nurse-targeted (NT) severe sepsis alert, and the implementation of the physician-targeted (PT) severe sepsis alert. When systemic inflammatory response syndrome criteria were met, the NT alert triggered, and when organ dysfunction was also identified, an interruptive PT alert triggered, and the respective clinician was paged to evaluate the patient. Our primary outcome measure was bundle compliance; our secondary measure was PT alert response compliance.
Results:
Baseline severe sepsis treatment bundle compliance was 37%. After requiring nursing response to the NT alert in 2016 and implementing the PT alert in 2018, our bundle compliance rose to 69% in 2020, demonstrating statistically significant difference (P = .006). PT alert response compliance rose from 67% in 2018 to 91% in 2020.
Conclusions:
An interruptive severe sepsis screening alert sent directly to clinicians is a valuable tool to ensure prompt severe sepsis recognition and treatment. This biphasic alert system facilitated multidisciplinary collaboration in early sepsis diagnosis and management.
