title: Effect of an electronic medical record alert for severe sepsis among ED patients.
abstract: BACKGROUND
  Severe sepsis and septic shock are a major health concern worldwide. The objective of this study is to determine if Severe Sepsis Best Practice Alert (SS-BPA) implementation was associated with improved processes of care and clinical outcomes among patients with severe sepsis or septic shock presenting to the emergency department (ED).
  
  
  METHODS
  This is a single-center, before-and-after observational study. The intervention group (n = 103) consisted of adult patients presenting to the ED with severe sepsis or septic shock during a 7-month period after implementation of the SS-BPA. The control group (n = 111) consisted of patients meeting the same criteria over a prior 7-month period. The SS-BPA primarily acts by automated, real-time, algorithm-based detection of severe sepsis or septic shock via the electronic medical record system. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), time to antibiotic administration, and proportion of patients who received antibiotics within the target 60 minutes.
  
  
  RESULTS
  Time to antibiotics was significantly reduced in the SS-BPA cohort (29 vs 61.5 minutes, P < .001). In addition, there was a higher proportion of patients who received antibiotics within 60 minutes (76.7 vs 48.6%; P < .001). On multivariable analysis, in-hospital mortality was not significantly reduced in the intervention group (odds ratio, 0.64; 95% confidence interval, 0.26-1.57). Multivariable analysis of LOS indicated a significant reduction among patients in the SS-BPA cohort (geometric mean ratio, 0.66; 95% confidence interval, 0.53-0.82).
  
  
  CONCLUSIONS
  Implementation of the SS-BPA for severe sepsis or septic shock among ED patients is associated with significantly improved timeliness of antibiotic administration and reduced hospital LOS.
authors.affiliation: Department of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, San Francisco, CA 94143. Electronic address: navan12@pharmacy.rutgers.edu.
authors.forename: Navaneeth
authors.initials: N
authors.lastname: Narayanan
authors.affiliation: Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, CA 94143.
authors.forename: A Kendall
authors.initials: AK
authors.lastname: Gross
authors.affiliation: Department of Pharmaceutical Services, University of California, San Francisco Medical Center, San Francisco, CA 94143.
authors.forename: Megan
authors.initials: M
authors.lastname: Pintens
authors.affiliation: Department of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco, CA 94143.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fee
authors.affiliation: Department of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, San Francisco, CA 94143.
authors.forename: Conan
authors.initials: C
authors.lastname: MacDougall
mesh_terms: D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents