Implementation and evaluation of sepsis surveillance and decision support in medical ICU and emergency department.
Am J Emerg Med
; 51: 378-383, 2022 Jan.
Article
em En
| MEDLINE
| ID: mdl-34823194
ABSTRACT
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 MAINRESULTS:
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Sepse
/
Sistemas de Apoio a Decisões Clínicas
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Serviço Hospitalar de Emergência
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Unidades de Terapia Intensiva
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article