Clinician Perception of the Effectiveness of an Automated Early Warning and Response System for Sepsis in an Academic Medical Center.
BACKGROUND
We implemented an electronic early warning and response system (EWRS) to improve detection of and response to severe sepsis. Sustainability of such a system requires stakeholder acceptance. We hypothesized that clinicians receiving such alerts perceive them to be useful and effective.


OBJECTIVE
To survey clinicians after EWRS notification about perceptions of the system.


METHODS
For a 6-week study period 1 month after EWRS implementation in a large tertiary referral medical center, bedside clinicians, including providers (physicians, advanced practice providers) and registered nurses (RNs), were surveyed confidentially within 2 hours of an alert.


RESULTS
For the 247 alerts that triggered, 127 providers (51%) and 105 RNs (43%) completed the survey. Clinicians perceived most patients as stable before and after the alert. Approximately half (39% providers, 48% RNs) felt the alert provided new information, and about half (44% providers, 56% RNs) reported changes in management as a result of the alert, including closer monitoring and additional interventions. Over half (54% providers, 65% RNs) felt the alert was appropriately timed. Approximately one-third found the alert helpful (33% providers, 40% RNs) and fewer felt it improved patient care (24% providers, 35% RNs).


CONCLUSIONS
A minority of responders perceived the EWRS to be useful, likely related to the perception that most patients identified were stable. However, management was altered half the time after an alert. These results suggest further improvements to the system are needed to enhance clinician perception of the system's utility.
Departments of 1 Medicine and.
Jessica L
JL
Guidi
Departments of 1 Medicine and.
Katherine
K
Clark
Departments of 1 Medicine and.
Mark T
MT
Upton
Departments of 1 Medicine and.
Hilary
H
Faust
Departments of 1 Medicine and.|2 Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Craig A
CA
Umscheid
3 Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, and.
Meghan B
MB
Lane-Fall
Departments of 1 Medicine and.
Mark E
ME
Mikkelsen
Departments of 1 Medicine and.
William D
WD
Schweickert
4 Information Services and.
Christine A
CA
Vanzandbergen
2 Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Joel
J
Betesh
4 Information Services and.
Gordon
G
Tait
2 Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Asaf
A
Hanish
Departments of 1 Medicine and.
Kirsten
K
Smith
Departments of 1 Medicine and.
Denise
D
Feeley
Departments of 1 Medicine and.
Barry D
BD
Fuchs
D000046:Academic Medical Centers / Q000458:organization & administration; D001291:Attitude of Health Personnel; D042241:Early Diagnosis; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D005791:Patient Care / Q000592:standards*; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000451:nursing; D011795:Surveys and Questionnaires
early warning systems; electronic medical record; sepsis and shock; survey design