Resumen de Electronic alerting and decision support for early sepsis detection and management: Impact on clinical outcomes

Patricia Martín Rico, Antonio Valdivia Pérez, Juan Manuel Lacalle Martínez

• Purpose: Notification systems based on information recorded in the Electronic Medical Record (EMR) can become a powerful tool for early detection of sepsis. We evaluated the validity of an electronic rule/alert for identifying Severe Sepsis and Septic Shock (SS/SS) and the impact of a Code Sepsis started by this electronic tool on in-hospital mortality. Method: The rule identifies SS/SS based on data collected in the EMR (Cerner Millennium®). The rule triggers an alert to clinicians for further assessment and management supported by a sepsis order set. First introduced in May 2013 in the Emergency Department (ED), we assess validity in those ED encounters in which the alert was triggered and became inpatients, using clinically confirmed hospital discharge diagnosis as the gold standard. Impact on mortality rate was assessed with a time series analysis from January 2011 through December 2013. Results: From May to December 2013, 33,723 ED encounters were registered. Alert fired in 3% of them (1,190); 63% (754) of these were admitted and 23% (178) of them were manually confirmed as SS/SS. Rule sensitivity was 80%, Specificity 89%, Positive Predictive Value 19%, Negative Predictive Value 99%. Compared to the pre-alert period, mortality rate decreased by 28% and adjusted mortality risk decreased by 36% (Incidence Rate Ratio [IRR] 0.64; 95% CI: 0.43-0.97; p = 0.036). Conclusions: Our electronic sepsis rule/alert allowed early detection of SS/SS in the ED, and in the frame of a Code Sepsis strategy showed a significant decrease in the mortality risk. Notification systems for SS/SS detection should form part of standard care provision