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Implementation of a real-time computerized sepsis alert in nonintensive care unit patients*

Sawyer, Amber M. PharmD; Deal, Eli N. PharmD; Labelle, Andrew J. MD; Witt, Chad MD; Thiel, Steven W. MD; Heard, Kevin BS; Reichley, Richard M. RPh; Micek, Scott T. PharmD; Kollef, Marin H. MD

doi: 10.1097/CCM.0b013e318205df85
Clinical Investigations

Objective: Early therapy of sepsis involving fluid resuscitation and antibiotic administration has been shown to improve patient outcomes. A proactive tool to identify patients at risk for developing sepsis may decrease time to interventions and improve patient outcomes. The objective of this study was to evaluate whether the implementation of an automated sepsis screening and alert system facilitated early appropriate interventions.

Design: Prospective, observational, pilot study.

Setting: Six medicine wards in Barnes-Jewish Hospital, a 1250-bed academic medical center.

Patients: Patients identified by the sepsis screen while admitted to a medicine ward were included in the study. A total of 300 consecutive patients were identified comprising the nonintervention group (n = 200) and the intervention group (n = 100).

Interventions: A real-time sepsis alert was implemented for the intervention group, which notified the charge nurse on the patient's hospital ward by text page.

Measurements and Main Results: Within 12 hrs of the sepsis alert, interventions by the treating physicians were assessed, including new or escalated antibiotics, intravenous fluid administration, oxygen therapy, vasopressors, and diagnostic tests. After exclusion of patients without commitment to aggressive management, 181 patients in the nonintervention group and 89 patients in the intervention group were analyzed. Within 12 hrs of the sepsis alert, 70.8% of patients in the intervention group had received ≥1 intervention vs. 55.8% in the nonintervention group (p = .018). Antibiotic escalation, intravenous fluid administration, oxygen therapy, and diagnostic tests were all increased in the intervention group. This was a single-center, institution- and patient-specific algorithm.

Conclusions: The sepsis alert developed at Barnes-Jewish Hospital was shown to increase early therapeutic and diagnostic interventions among nonintensive care unit patients at risk for sepsis.

From the Department of Pharmacy (AMS, END, STM), Barnes-Jewish Hospital, St Louis, MO; the Pulmonary and Critical Care Division (AJL, CW, SWT, MHK), Washington University School of Medicine, St Louis, MO; and Medical Informatics (KH, RMR), Barnes-Jewish Hospital, St Louis, MO.

This study was funded in part by the Barnes-Jewish Hospital Foundation.

The authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins