Posted on February 13, 2019
Early identification and treatment are the key to reducing the high cost of sepsis care and improving patient outcomes. Frequently, to improve performance, a hospital will use its EHR’s sepsis module, alerts and other functionality to accelerate accurate diagnosis and treatment. Unfortunately, the results delivered are marginal at best. The key areas of focus in the fight against sepsis are early recognition and the treatment of infection. The time-sensitive aspect of this disease is crucial because after the onset of severe sepsis, mortality rates increase by 7–10% per hour.
A complex sepsis care continuum
Sepsis is a clinical diagnosis. The delivery of evidence-based care to address the rapid change in biomarkers is the goal. Changing outcomes requires a hospital’s commitment to education and change management, adoption of evidence-based consensus guidelines and tools while complying with measures from the Center for Disease Control and other governing bodies. Not only do you have to prevent diagnostic errors, but clinicians also must make the diagnosis quickly and early to save lives.
Where EHRs fall short
Most commonly, EHR sepsis alerting systems utilize Systemic Inflammatory Response Syndrome (SIRS) criteria for sepsis surveillance. The sepsis detection system will trigger a “sepsis alert” if the EHR identifies SIRS criteria. Alternately, sometimes EHR systems deploy alerting systems using the Modified Early Warning System (MEWS) instead of SIRS. Regardless, both SIRS and MEWS-based alerting systems are known to be sensitive but have poor specificity. Today, some systems are starting to use the Sequential Organ Failure Assessment (SOFA) and qSOFA scoring systems for alerting, but these newer systems are already known to have poor sensitivity and a delay in identifying abnormalities.
Because of EHR’s lack of sensitivity and specificity in alerting, each fulfillment of additional sepsis criteria results in the repeat activation of a sepsis alert leading to:
Although EHR vendors have developed sepsis alerting that appears to be a bargain since it a “free” product, this has not proven to be the case. If one takes a closer look, in-house healthcare teams spend a great deal of energy and time on implementation and integration of the surveillance solution into their workflows in an (unsuccessful) attempt to improve its accuracy, costing time and important clinical resources.
There is a better answer. Third party surveillance technology used with an EHR can offer benefits to offset these gaps. Surveillance technology that focuses on accurate and timely alerting has moved the dial on detection and treatment by drawing on built-in intelligent clinical content and rules, and by incorporating change management services for hospitals. When accurate enough to account for a wide range of sophisticated clinical scenarios and relevant comorbid medical conditions, surveillance systems that deliver decision support to the point of care can improve outcomes where EHR-based systems have failed.
A 2016 study evaluated the impact of a computerized surveillance algorithm and decision support system such as this on sepsis mortality. The study evaluated – POC Advisor – a highly accurate system that used a combination of change management, computerized surveillance, and mobile point of care alerting to:
A highly-complex condition to diagnose and treat, sepsis is a prime target for technological intervention beyond the EHR. However, as is true in most forms of health IT, not all solutions are equal. Despite the early nature of this market, there are solutions, like POC Advisor, that have a track record of delivering provable and repeatable outcomes reducing sepsis mortality, morbidity and cost of care.
Dr. Menen Mathias
POC Advisor, Sentri 7, Safety & Surveillance
Wolters Kluwer Health
Menen Mathias is a physician informaticist and general surgeon. She has completed her Informatics Certification and has been working with Electronic Health Records (EHRs) for many years. As a member of NextGen Healthcare, she served as a senior physician consultant and held many leadership roles including transforming the NextGen Mobile application with the technical team and designing clinical decision support efficiencies. While at Maimonides Hospital, she led the implementation of the EHR at a large academic center.