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


CONCLUSIONS
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.


METHODS
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.
Chasen A
CA
Croft
Frederick A
FA
Moore
Philip A
PA
Efron
Peggy S
PS
Marker
Andrea
A
Gabrielli
Lynn S
LS
Westhoff
Lawrence
L
Lottenberg
Janeen
J
Jordan
Victoria
V
Klink
R Matthew
RM
Sailors
Bruce A
BA
McKinley
D000328:Adult; D015331:Cohort Studies; D003199:Computer Systems / Q000706:statistics & numerical data; D003422:Critical Care / Q000458:organization & administration; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D019468:Disease Management; D042241:Early Diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010209:Paper; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D013813:Therapy, Computer-Assisted / Q000592:standards*