title: Implementation of a real-time computerized sepsis alert in nonintensive care unit patients.
abstract: 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.
  
  
  METHODS
  Prospective, observational, pilot study.
  
  
  METHODS
  Six medicine wards in Barnes-Jewish Hospital, a 1250-bed academic medical center.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, and the Pulmonary and Critical Care Division, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Sawyer
authors.forename: Eli N
authors.initials: EN
authors.lastname: Deal
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Labelle
authors.forename: Chad
authors.initials: C
authors.lastname: Witt
authors.forename: Steven W
authors.initials: SW
authors.lastname: Thiel
authors.forename: Kevin
authors.initials: K
authors.lastname: Heard
authors.forename: Richard M
authors.initials: RM
authors.lastname: Reichley
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D056902:Clinical Alarms; D003428:Cross Infection / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D003936:Diagnosis, Computer-Assisted; D042241:Early Diagnosis; D005260:Female; D005440:Fluid Therapy; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D010865:Pilot Projects; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents