Accurate Detection and Reliable, Actionable Alerts
Many hospitals deploy automated systems as part of a sepsis program to identify patient risk so the appropriate therapies can be initiated quickly. These systems typically use an algorithm that combines patient data from the EHR such as demographics, vital signs, medications, and lab values.
Many systems are highly sensitive, but they’re not specific enough. They may detect common risk factors but don’t account for the complex comorbidities that can alter a patient’s condition, thereby triggering false positives. For example, factors related to liver disease and heart failure can trigger false-positive sepsis alerts.
Even if a system is sensitive and specific, it might not provide actionable information to the right person, in the right way, quickly enough to initiate the right response.
An effective sepsis surveillance and clinical decision support system needs to be accurate (highly sensitive and specific). It needs to be reliable, reaching the appropriate caregiver with the right information, at the right time, in the right way. And it needs to be actionable, providing clear instructions about what to do next.
- Make Alerts Accurate: To improve accuracy, the system needs to be highly specific. The algorithm used to detect sepsis should include the core stats from the EHR, and nursing and provider documentation. If the documents are free-texted, natural language processing should be used to extract medical conditions. The documentation provides information necessary to understand the combination of conditions and other treatments that apply to each patient.
- Make Alerts Reliable: Move sepsis alerts out of the routine flow of EHR notifications where they are likely to get lost in the shuffle. Instead, deliver them to caregivers on their mobile devices at the point of care. Using a common method for presenting and delivering sepsis risk alerts enables caregivers to trust alert accuracy. Build in escalation rules so that if the first recipient of an alert is not available, it is sent to another caregiver who can act upon it. Require the final recipient to acknowledge the alert.
- Make Alerts Actionable: Don’t just tell the nurse there’s a septic patient in room 101. Provide information about the level of the patient’s condition (such as severe sepsis), why the alert was triggered, and what to do next. The protocol at many hospitals is for the alert recipient to contact the patient’s physician to review the factors leading to the sepsis alert and confirm the appropriate order sets. With some systems, once the recipient has accepted the initial alert, a second alert can automatically be sent to another group, such as the rapid response team.
Vocera partners with providers of sepsis surveillance solutions to deliver accurate, reliable, and actionable alerts. Deploying the right workflows and technology, driving care team engagement, and managing performance improvement against defined goals are keys to a successful sepsis program. Do it right, and you can significantly improve patient outcomes.
References
1Dantes, Raymund B. and Epstein, Lauren. “Combatting Sepsis: A Public Health Perspective.” Oxford Academic, Clinical Infectious Diseases, Volume 67, Issue 8, 15 October 2018, Pages 1300–1302, https://doi.org/10.1093/cid/ciy342.
2McGregor C. “Improving time to antibiotics and implementing the ‘Sepsis 6’. BMJ Open Quality 2014; 2:u202548.w1443. doi: 10.1136/bmjquality.u202548.w1443, https://bmjopenquality.bmj.com/content/2/2/u202548.w1443.
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