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Computer versus paper system for recognition and management of sepsis in surgical intensive care

Croft, Chasen A. MD; Moore, Frederick A. MD; Efron, Philip A. MD; Marker, Peggy S. MSN; Gabrielli, Andrea MD; Westhoff, Lynn S. BSN; Lottenberg, Lawrence MD; Jordan, Janeen MD; Klink, Victoria BSN; Sailors, R. Matthew BE; McKinley, Bruce A. PhD

Journal of Trauma and Acute Care Surgery: February 2014 - Volume 76 - Issue 2 - p 311–319
doi: 10.1097/TA.0000000000000121
2013 AAST Plenary Papers

BACKGROUND A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes.

METHODS A system was designed to provide early recognition and guide patient-specific management of sepsis including (1) modified early warning signs–sepsis recognition score (MEWS-SRS; summative point score of ranges of vital signs, mental status, white blood cell count; after every 4 hours) by bedside nurse; (2) suspected site assessment (vascular access, lung, abdomen, urinary tract, soft tissue, other) at bedside by physician or extender; (3) sepsis management protocol (replicable, point-of-care decisions) at bedside by nurse, physician, and extender. The system was implemented first using paper and then a computerized system. Sepsis severity was defined using standard criteria.

RESULTS In January to May 2012, a paper system was used to manage 77 consecutive sepsis encounters (3.9 ± 0.5 cases per week) in 65 patients (77% male; age, 53 ± 2 years). In June to December 2012, a computerized system was used to manage 132 consecutive sepsis encounters (4.4 ± 0.4 cases per week) in 119 patients (63% male; age, 58 ± 2 years). MEWS-SRS elicited 683 site assessments, and 201 had sepsis diagnosis and protocol management. The predominant site of infection was abdomen (paper, 58%; computer, 53%). Recognition of early sepsis tended to occur more using the computerized system (paper, 23%; computer, 35%). Hospital mortality rate for surgical ICU sepsis (paper, 20%; computer, 14%) was less with the computerized system.

CONCLUSION A computerized sepsis management system improves care process and outcome. Early sepsis is recognized and managed with greater frequency compared with severe sepsis or septic shock. The system has a beneficial effect as a clinical standard of care for SICU patients.

LEVEL OF EVIDENCE Therapeutic study, level III.

From the Departments of Surgery (C.A.C., F.A.M., P.A.E., L.L., J.J., V.K., R.M.S., B.A.M.) and Anesthesiology (A.G.), College of Medicine, University of Florida; and Trauma ICU (P.S.M.) and Surgery ICU (L.S.W.), UFHealth, Shands Hospital Gainesville, Florida.

Submitted: July 7, 2013, Revised: November 5, 2013, Accepted: November 6, 2013.

This study was presented at the 72nd annual meeting of the American Association for the Surgery of Trauma, September 18–21, 2013, in San Francisco, California.

Address for reprints: Bruce A. McKinley, PhD, Division of Acute Care Surgery, Department of Surgery, Health Science Center, PO Box 100108, Gainesville, FL; email:

© 2014 Lippincott Williams & Wilkins, Inc.