Sepsis: Earlier Detection With New Clinical Surveillance Tool

September is National Sepsis Month, and when a patient is in septic shock, it kills 34% of the time. Sepsis is a deadly, expensive, and difficult to diagnose medical condition, and often the clues within the medical record do not come together for early detection.

One tool many hospitals use is the standard systemic inflammatory response syndrome-triggered electronic health record (EHR) alerts that aid in detection. However, the detective work is still mostly by time-consuming retrospection because the information the EHR alerts send are often wrong or misleading, and health care professionals (HCPs) end up with alert-fatigue and do not pay attention to the signals. However, what if the alerts were more accurate and more often gave earlier information to those HCPs who need the information?

Blessing Health System (Blessing), an integrated health system in Quincy, Illinois, was searching for an answer and selected POC Advisor from Wolters Kluwer, Health to more quickly identify and treat patients with sepsis or sepsis shock—up to 6 hours earlier—leading to possibly better patient outcomes.

Mary Barthel, MD, a hospitalist and the chief quality and safety officer for Blessing Health spoke with Infection Control Today^® (ICT^®) about sepsis and describe how Blessing Health using this new innovation to manage information to pinpoint patients at risk of sepsis and save patient lives easier and faster.

ICT^®: What is sepsis, and why is it so deadly?

Mary Barthel, MD: Sepsis is the body's response to an infection. The body triggers a chain reaction, and that reaction can damage your own tissues. If left untreated, it can progress to septic shock, which is when the blood pressure drops, which can lead to severe organ problems and even death. If we intervene and give early treatment with antibiotics and IV fluids, it improves the chances for survival. But without treatment, sepsis can lead to tissue damage and even death.

ICT^®: Would you please describe the POC Advisor’s role?

MB: Point of care (POC) Advisor is a clinical decision support tool. What does that mean? Clinical decision support tools take data, usually from our electronic medical records, and turns it into actionable information to help the clinicians decide about a patient's care. They take over some of the routine tasks and can recognize changes in vital signs, changes in labs, and then warn the clinicians of potential problems or prompt suggestions for the clinical team to consider. In this case, the tool searches our medical record for signs and symptoms of possible sepsis, and then alerts the nurses and doctors taking care of the patient that sepsis might be present.

ICT^®: Please walk us through the Blessing Health collaborative approach.How does the POC Advisor fit in?

MB: Blessing has been working with a multidisciplinary sepsis committee for more than a decade. The surviving sepsis campaign came out with international guidelines back in 2004. Then in 2011, we revamped our multidisciplinary team, and it has met monthly ever since. It's currently led by a fulltime registered nurse sepsis care coordinator. The committee meets and collaborates to produce standardized evidence-based order sets. We have a nurse-driven sepsis screening protoco; we have a nurse-driven testing, order-set protocol. We have a code sepsis alert that can go off that can get clinicians to the bedside quickly to assess the patient, implemented technology to assess fluid responsiveness in our patients. All of these different interventions have allowed us to demonstrate significant improvement in our sepsis core measure and our sepsis mortality. But we still have opportunity in the population of patients who don't have sepsis on admission. They're admitted to the hospital for other reasons, and then they develop sepsis. So POC Advisor will provide one more layer to helping our clinicians recognize when a patient is starting to develop signs and symptoms of sepsis, especially on our medical-surgical floors, and then give an alert to our clinicians, so they can make timely decisions.

ICT^®: Do you have an infection preventionist on staff, and now does that individual interact with the POC advisor?

MB: The role that would be closest to what you're referring to would be our sepsis coordinator. She's a registered nurse, and she's in charge of our sepsis program. She chairs our sepsis committee meetings. She's developed a lot of the tools that I mentioned before, but she's the one right now piloting with the POC Advisor, getting all the alerts on any patient inhouse who fires a risk for possible sepsis. Then she's reaching out either looking in the EMR or reaching out to the bedside staff to investigate to confirm if sepsis is present, and then to notify clinicians that the alert suggests possible sepsis and when the patient needs more of a workup.

ICT^®: How is this new approach making an impact at Blessing Health?

MB: It's early to come to any conclusions about outcomes. But I think [POC Advisor] is one more layer. It's a tool that can alert our staff to be aware that there appear to be some changes in that patient, whether it's vital signs or labs or new signs or symptoms of infections. Like I said, the population that we hope to impact the most is those who aren't admitted with sepsis. We don't know that they have sepsis, and then they develop signs and symptoms after admission. So that's the population that we're targeting.

ICT^®: Of the patients with sepsis, do more come to the hospital with that diagnosis or with another unrelated diagnosis?

Most of our cases, though, would come in with a known diagnosis of sepsis, and they're recognized and treated in the emergency room. Then there's a smaller group of patients who come in, and they might have pneumonia or an infection, or they might not, but then they develop or start to exhibit signs of [sepsis] later, and those are the ones who are a little harder to capture.