Effect of an electronic medical record alert for severe sepsis among ED patients.

BACKGROUND Severe sepsis and septic shock are a major health concern worldwide. The objective of this study is to determine if Severe Sepsis Best Practice Alert (SS-BPA) implementation was associated with improved processes of care and clinical outcomes among patients with severe sepsis or septic shock presenting to the emergency department (ED). METHODS This is a single-center, before-and-after observational study. The intervention group (n = 103) consisted of adult patients presenting to the ED with severe sepsis or septic shock during a 7-month period after implementation of the SS-BPA. The control group (n = 111) consisted of patients meeting the same criteria over a prior 7-month period. The SS-BPA primarily acts by automated, real-time, algorithm-based detection of severe sepsis or septic shock via the electronic medical record system. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), time to antibiotic administration, and proportion of patients who received antibiotics within the target 60 minutes. RESULTS Time to antibiotics was significantly reduced in the SS-BPA cohort (29 vs 61.5 minutes, P < .001). In addition, there was a higher proportion of patients who received antibiotics within 60 minutes (76.7 vs 48.6%; P < .001). On multivariable analysis, in-hospital mortality was not significantly reduced in the intervention group (odds ratio, 0.64; 95% confidence interval, 0.26-1.57). Multivariable analysis of LOS indicated a significant reduction among patients in the SS-BPA cohort (geometric mean ratio, 0.66; 95% confidence interval, 0.53-0.82). CONCLUSION Implementation of the SS-BPA for severe sepsis or septic shock among ED patients is associated with significantly improved timeliness of antibiotic administration and reduced hospital LOS.

[1]  G. Patel,et al.  Impact of the implementation of a sepsis protocol for the management of fluid-refractory septic shock: A single-center, before-and-after study. , 2010, Clinical therapeutics.

[2]  W. Judd,et al.  Clinical and Economic Impact of a Quality Improvement Initiative to Enhance Early Recognition and Treatment of Sepsis , 2014, The Annals of pharmacotherapy.

[3]  K. Wood,et al.  Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock* , 2006, Critical care medicine.

[4]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[5]  A. Flannery,et al.  Utilization of Pharmacist Responders as a Component of a Multidisciplinary Sepsis Bundle , 2014, The Annals of pharmacotherapy.

[6]  Garrett E. Schramm,et al.  Septic shock: A multidisciplinary response team and weekly feedback to clinicians improve the process of care and mortality* , 2011, Critical care medicine.

[7]  M. Levy,et al.  Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour: Results From a Guideline-Based Performance Improvement Program* , 2014, Critical care medicine.

[8]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 , 2013, Critical care medicine.

[9]  G. Westphal,et al.  Reduced mortality after the implementation of a protocol for the early detection of severe sepsis. , 2011, Journal of critical care.

[10]  Derek C Angus,et al.  Severe sepsis epidemiology: sampling, selection, and society , 2004, Critical care.

[11]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.

[12]  J. Sunderram,et al.  Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003* , 2007, Critical care medicine.

[13]  Javier Llorca,et al.  Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: Results of a three-year follow-up quasi-experimental study* , 2010, Critical care medicine.

[14]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012 , 2013, Intensive Care Medicine.

[15]  Richard Beale,et al.  The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis , 2010, Intensive Care Medicine.

[16]  Robert Steele,et al.  Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality* , 2007, Critical care medicine.