Electronic Sepsis Screening Among Patients Admitted to Hospital Wards: A Stepped-Wedge Cluster Randomized Trial

Area of Science:

• Clinical Medicine
• Health Informatics
• Critical Care Medicine

Background:

• Sepsis screening is recommended for hospitalized patients, yet evidence for its effectiveness is limited.
• Early detection and intervention are crucial for improving sepsis patient outcomes.

Purpose of the Study:

• To evaluate the impact of electronic sepsis screening versus no screening on mortality in hospitalized ward patients.
• To assess the effectiveness of an electronic sepsis alert system in a real-world hospital setting.

Main Methods:

• A stepped-wedge, cluster randomized trial was conducted across 5 hospitals in Saudi Arabia.
• 45 wards were randomized, with electronic sepsis screening (based on quick Sequential Organ Failure Assessment score) implemented in a phased manner.
• The study included 60,055 patients, with 90-day in-hospital mortality as the primary outcome.

Main Results:

• Electronic sepsis screening led to a significant reduction in 90-day in-hospital mortality (adjusted relative risk, 0.85; P < .001).
• Patients in the screening group were more likely to receive timely lactate testing and intravenous fluids.
• While reducing vasopressor use and multidrug-resistant organisms, screening increased code blue activations and kidney replacement therapy.

Conclusions:

• Electronic sepsis screening is associated with a significant decrease in in-hospital mortality among hospitalized ward patients.
• The findings support the implementation of electronic sepsis screening tools to improve patient survival.
• Further research may be needed to optimize screening protocols and mitigate potential adverse effects.