Digital alert helps speeds sepsis treatment in test at London system

A London healthcare delivery system is using a digital alert to help remind physicians to look for signs of sepsis in the emergency department.

The technology-based reminder system speeds the time it takes for doctors to check for signs of sepsis early in an emergency department visit, which quickens the administration of antibiotics.

Sepsis is a common health issue in the U.K.; the nation has reported 123,000 cases and 46,000 deaths annually. Consequently, UK hospitals have a goal of administering antibiotics intravenously to suspected sepsis patients within one hour.

NHS-hospital-CROP.jpg
The Royal Homeopathic hospital stands in Great Ormond Street, in London, U.K., on Wednesday, March 19, 2008. The NHS treatment takes place at the hospital which is based in central London. Photographer: Graham Barclay/Bloomberg News

Embedding sepsis tools into the electronic health record enables use of digital alerts to physicians, based on current and past clinical measurements. For example, Cerner has developed a digital sepsis alert that has a silent running mode. Silent alerts are not visible to doctors at the front end of the system, but once an alert is turned on, nurses are notified of patients who have triggered the alert via a pop-up warning on the EHR.

In addition to the alert, the London hospital network offers a multidisciplinary care pathway that launches from the digital record when the clinician confirms suspicion of sepsis. These pathways are treatment plans that support the clinician to start treatment in-line with hospital guidance that includes administering fluids, oxygen, diagnostic tests and early antibiotics.

Further, content from local infection guidelines are built-in so that for any given potential sepsis diagnosis the appropriate antibiotics with appropriate dosing and directions are prompted.

The report is the first evaluation of a digital sepsis alert in an English hospital and the largest undertaken anywhere to date, researchers say. Overall, 6 percent of patients who alerted as possible sepsis patients died within 30 days of the alert (all-cause, in-hospital) and this is in a hospital network with a lower than expected overall in-hospital mortality.

“However, patients for whom their first alert was during the live phase of the program had lower odds of death, lower odds of long hospital stay, and increased odds of receiving timely antibiotics,” according to researchers.

“These results suggest an important clinical benefit from the introduction of alerting, although it is not possible to say the extent to which the presence of alerting, per se, is responsible for the benefits seen, or whether the alert acted as a useful driver for other quality improvement initiatives,” they conclude.

For reprint and licensing requests for this article, click here.