Evaluating the impact of a computerized surveillance algorithm and decision support system on sepsis mortality

• Published in: Journal of the American Medical Informatics Association : JAMIA 2017-01, Vol.24 (1), p.88-95
• Main Authors: Manaktala, Sharad, Claypool, Stephen R
• Format: Article
• Language: English
• Subjects: Alabama; Algorithms; Decision Support Systems, Clinical; Female; Hospital Mortality; Hospitals, Teaching; Humans; Male; Middle Aged; Mobile Applications; Monitoring, Physiologic - methods; Quality Improvement; Research and Applications; Sensitivity and Specificity; Sepsis - diagnosis; Sepsis - mortality
• ISSN: 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocw056

Objective: We created a system using a triad of change management, electronic surveillance, and algorithms to detect sepsis and deliver highly sensitive and specific decision support to the point of care using a mobile application. The investigators hypothesized that this system would result in a reduction in sepsis mortality. Methods: A before-and-after model was used to study the impact of the interventions on sepsis-related mortality. All patients admitted to the study units were screened per the Institute for Healthcare Improvement Surviving Sepsis Guidelines using real-time electronic surveillance. Sepsis surveillance algorithms that adjusted clinical parameters based on comorbid medical conditions were deployed for improved sensitivity and specificity. Nurses received mobile alerts for all positive sepsis screenings as well as severe sepsis and shock alerts over a period of 10 months. Advice was given for early goal-directed therapy. Sepsis mortality during a control period from January 1, 2011 to September 30, 2013 was used as baseline for comparison. Results: The primary outcome, sepsis mortality, decreased by 53% (P = 0.03; 95% CI, 1.06-5.25). The 30-day readmission rate reduced from 19.08% during the control period to 13.21% during the study period (P = 0.05; 95% CI, 0.97-2.52). No significant change in length of hospital stay was noted. The system had observed sensitivity of 95% and specificity of 82% for detecting sepsis compared to gold-standard physician chart review. Conclusion: A program consisting of change management and electronic surveillance with highly sensitive and specific decision support delivered to the point of care resulted in significant reduction in deaths from sepsis.