title: Development, implementation, and impact of an automated early warning and response system for sepsis.
abstract: BACKGROUND
  Early recognition and timely intervention significantly reduce sepsis-related mortality.
  
  
  OBJECTIVE
  Describe the development, implementation, and impact of an early warning and response system (EWRS) for sepsis.
  
  
  METHODS
  After tool derivation and validation, a preimplementation/postimplementation study with multivariable adjustment measured impact.
  
  
  METHODS
  Urban academic healthcare system.
  
  
  METHODS
  Adult non-ICU patients admitted to acute inpatient units from October 1, 2011 to October 31, 2011 for tool derivation, June 6, 2012 to July 5, 2012 for tool validation, and June 6, 2012 to September 4, 2012 and June 6, 2013 to September 4, 2013 for the preimplementation/postimplementation analysis.
  
  
  METHODS
  An EWRS in our electronic health record monitored laboratory values and vital signs in real time. If a patient had ≥4 predefined abnormalities at any single time, the provider, nurse, and rapid response coordinator were notified and performed an immediate bedside patient evaluation.
  
  
  METHODS
  Screen positive rates, test characteristics, predictive values, and likelihood ratios; system utilization; and resulting changes in processes and outcomes.
  
  
  RESULTS
  The tool's screen positive, sensitivity, specificity, and positive and negative predictive values and likelihood ratios for our composite of intensive care unit (ICU) transfer, rapid response team call, or death in the derivation cohort was 6%, 16%, 97%, 26%, 94%, 5.3, and 0.9, respectively. Validation values were similar. The EWRS resulted in a statistically significant increase in early sepsis care, ICU transfer, and sepsis documentation, and decreased sepsis mortality and increased discharge to home, although neither of these latter 2 findings reached statistical significance.
  
  
  CONCLUSIONS
  An automated prediction tool identified at-risk patients and prompted a bedside evaluation resulting in more timely sepsis care, improved documentation, and a suggestion of reduced mortality.
authors.affiliation: Center for Evidence-based Practice, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
authors.forename: Joel
authors.initials: J
authors.lastname: Betesh
authors.forename: Christine
authors.initials: C
authors.lastname: VanZandbergen
authors.forename: Asaf
authors.initials: A
authors.lastname: Hanish
authors.forename: Gordon
authors.initials: G
authors.lastname: Tait
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
mesh_terms: D000368:Aged; D057286:Electronic Health Records / Q000639:trends; D005260:Female; D006284:Health Plan Implementation / Q000379:methods* / Q000639:trends; D057209:Hospital Rapid Response Team / Q000639:trends; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized / Q000639:trends; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods* / Q000639:trends; D016730:Program Development / Q000379:methods*; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*