Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 4, 2021
Date Accepted: Apr 30, 2021
A Real-Time Monitoring Platform for Optimal Sepsis Care: Design, Implementation and Validation in an Emergency Department
ABSTRACT
Background:
Sepsis is the leading cause of death in US hospitals. Compliance with bundled care, specifically serial lactates, blood cultures and antibiotics, improves outcomes but is often delayed or missed altogether in a busy practice environment.
Objective:
To design, implement, and validate a novel monitoring and alerting platform that provides real-time feedback to frontline Emergency Department (ED) providers regarding adherence to bundled care.
Methods:
This single center prospective observational study occurred in three phases: (1) the design and technical development phase to build an initial version of the platform; (2) the pilot phase to test and refine the platform in the clinical setting, (3) the post-pilot rollout phase to fully implement the study intervention.
Results:
During design and technical development, study team members and stakeholders identified criteria for patient inclusion, selected bundle measures for alerting, and defined alert thresholds, message content, delivery mechanisms, and recipients. Additional refinements were made based on 70 provider survey results during the pilot phase. During the 48 days of the post-pilot rollout phase, 15,770 ED encounters were tracked and 711 patient encounters ruled into the active monitoring cohort. In total, 634 pages were sent at a rate of 0.98 per attending physician shift. Overall, 272 (38.3%) patients had at least one page. Missing bundle elements that triggered alerts included: antibiotics 136 (42.6%), repeat lactate 106 (32.4%), blood cultures 68 (20.8%), and initial lactate 17 (5.2%). Of the missing SEP-1 elements for which a page was sent, 125 out of 327 (38.2%) were successfully completed on time.
Conclusions:
A real-time sepsis care monitoring and alerting platform was created for the ED environment. The high proportion of patients with at least one alert suggested the significant potential for such a platform to improve care, while the overall number of alerts per clinician suggested a low risk of alarm fatigue. The study intervention warrants more rigorous evaluation to ensure that the added alerts lead to better outcomes for patients with sepsis.
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