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Using System Inflammatory Response Syndrome as an Easy-to-Implement, Sustainable, and Automated Tool for All-Cause Deterioration Among Medical Inpatients

Fogerty, Robert L., MD, MPH*†; Sussman, L. Scott, MD; Kenyon, Kathleen, RN; Li, Fangyong, MPH; Sukumar, Nitin, MS; Kliger, Alan S., MD*†; Acker, Kurt, RN; Sankey, Christopher, MD*†

doi: 10.1097/PTS.0000000000000463
Original Article: PDF Only

Objectives Clinical deterioration detection among adult inpatients is known to be suboptimal, and many electronic health record tools have been developed to help identify these patients. Many of these tools are focused on sepsis spectrum disorders, but the evolution of the definition of sepsis is moving toward increased specificity, which may make automated detection of clinical deterioration from nonsepsis-related conditions less likely. The objectives of this study were to develop and to examine the use of a low-cost, highly sustainable deterioration detection tool based on systemic inflammatory response syndrome (SIRS) criteria.

Methods Using existing resources, a SIRS-based electronic health record monitoring and intervention tool was developed with a focus on ease of implementation and high sustainability. This tool was used to monitor 15,739 adult inpatients in real time during their admission.

Results The SIRS-based tool, created with focus on ease of implementation and high sustainability, identified patients with higher risk of clinical deterioration. The project was rapidly deployed for a 4-month period at a 900-bed campus of an academic medical center with minimal additional resources required.

Conclusions Whereas the definition of sepsis moves away from SIRS, SIRS-based criteria may still have clinical benefit as an easy-to-automate detection tool for all-cause clinical deterioration among medical inpatients.

From the *Department of Internal Medicine, Yale School of Medicine; †Yale New Haven Hospital, Yale New Haven Health System; and ‡Yale Center for Analytical Sciences, Yale University, New Haven, Connecticut.

Correspondence: Robert L. Fogerty, MD, MPH, Section of General Internal Medicine, Yale School of Medicine, PO Box 208093, New Haven, CT 06520 (e-mail:

The authors disclose no conflict of interest.

The study was supported by by MCIC Vermont.

All authors had access to the data and prepared the article.

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