Trend of mortality and length of stay in the emergency department following implementation of a centralized sepsis alert system.

Introduction: Sepsis alerts based on laboratory and vital sign criteria were found insufficient to improve patient outcomes. While most early sepsis alerts were implemented into smaller scale operating systems, a centralized new approach may provide more benefits, overcoming alert fatigue, improving deployment of staff and resources, and optimizing the overall management of sepsis. The objective of the study was to assess mortality and length of stay (LOS) trends in emergency department (ED) patients, following the implementation of a centralized and automated sepsis alert system. Methods: The automated sepsis alert system was implemented in 2021 as part of a hospital-wide command and control center. Administrative data from the years 2018 to 2021 were collected. Data included ED visits, in-hospital mortality, triage levels, LOS, and the Canadian Triage and Acuity Scale (CTAS). Results: Mortality rate for patients classified as CTAS I triage level was the lowest in 2021, after the implementation of the automated sepsis alert system, compared to 2020, 2019, and 2018 (p < 0.001). The Kaplan-Meier survival curve revealed that for patients classified as CTAS I triage level, the probability of survival was the highest in 2021, after implementation of the sepsis alert algorithm, compared to previous years (Log Rank, Mantel-Cox, χ²=29.742, p < 0.001). No significant differences in survival rate were observed for other triage levels. Conclusion: Implementing an automated sepsis alert system as part of a command center operation significantly improves mortality rate associated with LOS in the ED for patients in the highest triage level. These findings suggest that a centralized early sepsis alert system has the potential to improve patient outcomes.

A command centre implementation before and during the COVID-19 pandemic in a community hospital.

INTRODUCTION: The objective of the study was to assess the effects of high-reliability system by implementing a command centre (CC) on clinical outcomes in a community hospital before and during COVID-19 pandemic from the year 2016 to 2021. METHODS: A descriptive, retrospective study was conducted at an acute care community hospital. The administrative data included monthly average admissions, intensive care unit (ICU) admissions, average length of stay, total ICU length of stay, and in-hospital mortality. In-hospital acquired events were recorded and defined as one of the following: cardiac arrest, cerebral infarction, respiratory arrest, or sepsis after hospital admissions. A subgroup statistical analysis of patients with in-hospital acquired events was performed. In addition, a subgroup statistical analysis was performed for the department of medicine. RESULTS: The rates of in-hospital acquired events and in-hospital mortality among all admitted patients did not change significantly throughout the years 2016 to 2021. In the subgroup of patients with in-hospital acquired events, the in-hospital mortality rate also did not change during the years of the study, despite the increase in the ICU admissions during the COVID-19 pandemic.Although the in-hospital mortality rate did not increase for all admitted patients, the in-hospital mortality rate increased in the department of medicine. CONCLUSION: Implementation of CC and centralized management systems has the potential to improve quality of care by supporting early identification and real-time management of patients at risk of harm and clinical deterioration, including COVID-19 patients.

Physician Experience with Electronic Order Sets.

BACKGROUND: Electronic medical record (EMR) and electronic health record (EHR) are used interchangeably to describe a computerized medical information system that collects, stores and displays patient information (Boonstra and Broekhuis 2010). Blumenthal and Tavenner (2010) suggested that computerized medical implementation improves decision-making and patient management. As part of its EMR, Humber River Hospital has implemented electronic order sets (EOSs) by building them into the computerized physician order entry (CPOE) system. Electronic prescribing renders paper prescriptions obsolete as it reduces errors; increases accuracy; and enhances efficiency, compliance and record-keeping (Canada Health Infoway 2017). OBJECTIVE: The aim of this research was to explore physicians' perspectives and experiences using EOSs. METHODS: This qualitative study examined the perceptions of various physicians on the impact of EOSs. Data were collected through semi-structured, in-depth interviews with eligible physicians. Domains explored included usability, efficiency, safety and implications for the physician profession. RESULTS: Major themes that emerged included usability, efficiency and safety. Several implications for physician practice were also revealed. CONCLUSION: The findings from our study support previous studies that describe the benefits of EOSs, including ease of use and efficiency, real-time information that is evidence-based, increased safety and minimization of memory burden. EOSs were not perceived to be a replacement for clinical reasoning.