The clinical decision support system for sepsis as an important part of the medical and economic component of a hospital

Abstract

Aim: To evaluate an impact of a clinical decision support system (CDSS) in the clinical practice of a hospital on the quality and costs of treatment of patients with severe sepsis and septic shock.Materials and methods: We performed a retrospective analysis of the database in the medical information system qMS (SP.ARM, Russia, St. Petersburg) from 2015 to 2017 on 37,997 patients. In the first study period from January 2015 to June 2016, we analyzed the results of the conventional treatment regimen. From May to June 2016, the CDSS module was implemented into the qMS and the personnel was trained correspondingly. The data collected during the second study period mirrored the results of sepsis treatment with the use of CDSS. We assessed the average number of in-hospital days, duration of stay in the intensive care unit, number of septic shock cases, mortality, and treatment costs.Results: The diagnosis of sepsis was confirmed in 67 patients: in 1.4‰ (27/18,792) before the CDSS was implemented versus 2.1‰ (40/19,205) after the CDSS implementation (p < 0.01). It was found that the use of CDSS integrated into the hospital medical information system reduced the number of cases of septic shock development (p < 0.05). Lethality decreased by 10%. The sepsis-associated mortality showed a non-significant trend to decrease by 10% (p < 0.1). The implementation of the CDSS incorporated into the qMS helped to reduce the number of septic shock cases from 26% (7/27) to 7.5% (3/40) (p < 0.05). There was also a trend towards reduced duration of stay in intensive care unit, as well as towards decreased costs of sepsis treatment by 13% and efferent (extra-corporeal) treatments by 29%; however, the differences were not significant.Conclusion: The CDSS implementation for electronic monitoring of the patient's condition and changes in his/hers parameters allowed for an earlier diagnosis of sepsis. We identified some prerequisites for more rational utilization of medical resources, mainly due to early, targeted treatment of patients with severe sepsis and septic shock; however, additional studies are necessary.