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Updated: Jun 21, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive
Stacey M Sears1,2, Anisha K Coughlin1, Kathryn Nelson3
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States.
Insights
Automated sepsis screening tools in pediatric ICUs show promise but require refinement. Addressing alert fatigue through education, technology, and patient safety improvements is crucial for effective early sepsis recognition.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Patient safety
Background:
- The Pediatric Surviving Sepsis Campaign advocates for automated tools to enhance early sepsis recognition.
- C.S. Mott Children's Hospital implemented an electronic medical record (EMR)-based sepsis screening system in its Pediatric Intensive Care Unit (PICU) in 2019.
Purpose of the Study:
- To analyze the implementation of an EMR-based sepsis screening tool in a PICU.
- To identify barriers and facilitators to the tool's effective use.
- To gather frontline provider feedback on end-user experience.
Main Methods:
- Analysis of automated primary sepsis alerts, secondary screens, and bedside huddles over two periods (Nov 2019-Jan 2020 and Nov 2020-Jan 2021).
- Distribution of surveys to frontline providers (nurses and medical providers) to assess user experience.
- Evaluation of alert data and survey responses to identify implementation challenges and successes.
Main Results:
- In Cohort 1, 895 primary alerts yielded 503 secondary screens and 40 huddles. In Cohort 2, 925 primary alerts yielded 532 secondary screens and 12 huddles.
- Facilitators included positive provider perceptions of bedside huddles (73% of nurses, 74% of medical providers).
- Key barriers were the high volume of primary alerts and a significant rate of false alerts, often triggered by routine respiratory therapy.
Conclusions:
- EMR-based sepsis screening shows potential for early recognition but faces challenges.
- Successful implementation necessitates a focus on education, technology optimization, and patient safety protocols.
- Refinement of the system is essential to mitigate alert fatigue and ensure sustained clinical utility.
Introduction:
The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S. Mott Children's Hospital Pediatric Intensive Care Unit deployed an electronic medical record (EMR)-based screening for early recognition and treatment of sepsis.
Materials And Methods:
We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience.
Results:
In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions.
Discussion:
Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety.
Conclusion:
While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue.
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