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Abstract
BackgroundSepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment.ObjectiveThis study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care.MethodsThis single-center, prospective, observational study was conducted in three phases: the design and technical development phase to build an initial version of the platform; the pilot phase to test and refine the platform in the clinical setting; and the postpilot rollout phase to fully implement the study intervention.ResultsDuring the design and technical development, study team members and stakeholders identified the criteria for patient inclusion, selected bundle measures from the Center for Medicare and Medicaid Sepsis Core Measure for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase, including removing alerts for vasopressor initiation and modifying text in the pages to facilitate patient identification. During the 48 days of the postpilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters were included in the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 38.3% (272/711) patients had at least one page. The missing bundle elements that triggered alerts included: antibiotics 41.6% (136/327), repeat lactate 32.4% (106/327), blood cultures 20.8% (68/327), and initial lactate 5.2% (17/327). Of the missing Sepsis Core Measures elements for which a page was sent, 38.2% (125/327) were successfully completed on time.ConclusionsA real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, whereas the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis.
Highlights
Sepsis BackgroundSepsis is the leading cause of death in US hospitals [1], accounting for 6% of all hospitalizations and 35% of all inpatient deaths [2]
International guidelines and the Centers for Medicare and Medicaid Services (CMS) Sepsis Core Measures (SEP-1) bundle emphasize the importance of adhering to specific steps in the diagnosis and management of sepsis [4]
In consultation with emergency department (ED) Quality and Safety leadership, it was determined that patients should qualify for monitoring if they met the criteria for possible sepsis based on an electronic health record (EHR)–derived algorithm that existed before this study
Summary
Sepsis BackgroundSepsis is the leading cause of death in US hospitals [1], accounting for 6% of all hospitalizations and 35% of all inpatient deaths [2]. Consistent adherence can be very challenging, especially in the setting of a busy emergency department (ED), ward, or intensive care unit, where there are multiple simultaneous demands on providers’ attention. In this environment, SEP-1 bundle care can be delayed or missed, even when team members are knowledgeable about best practices in sepsis care [5]. Compliance with bundled care, serial lactates, blood cultures, and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment. Objective: This study aims to design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline emergency department (ED) providers regarding adherence to bundled care. The study intervention warrants a more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis
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