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EARLY RECOGNITION OF SEPSIS THROUGH THE ELECTRONIC HEALTH RECORD: A NEW HEALTHCARE INNOVATION 

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EARLY RECOGNITION OF SEPSIS THROUGH THE ELECTRONIC HEALTH RECORD: A NEW HEALTHCARE INNOVATION 

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One of the leading causes of death in the acute care setting is sepsis and septic shock. Early recognition of sepsis can lead to lower mortality rates and better outcomes for patients. The early sepsis recognition algorithm embedded in the electronic health record (EHR), is a new healthcare innovation. This algorithm allows healthcare providers to recognize, diagnose, and treat sepsis earlier and faster than ever before.

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The 2019 article by authors Amland and Hahn-Cover highlights a cloud-based computerized sepsis clinical decision support system (CDS). The CDS gives providers and nurses a heads-up when a patient's vital signs and lab results indicate the patient is exhibiting systemic inflammatory response syndrome (SIRS) or sepsis.  The researchers performed a multiple center retrospective cohort study at five different medical centers in four distinct geographic regions across the United States (Amland and Hahn-Cover, 2019). All facilities had an enterprise electronic health record (EHR) system (Amland and Hahn-Cover, 2019).

The authors explain that the sepsis CDS runs in real-time to identify patients with SIRS or severe SIRS criteria captured in the EHR and analyzed within the cloud platform (Amland and Hahn-Cover, 2019).  "The sepsis CDS has distinct activation definitions for SIRS and severe SIRS. If clinical criteria align, an alert is activated, and criteria are saved with timestamp information. When the sepsis CDS is in live surveillance mode, notifications are delivered to providers for action" (Amland and Hahn-Cover, 2019, p. 495).

The results of this study showed that the cloud-based sepsis CDS correctly classified 5682 of 6200 patients, accurately detected 379 of 459 patients, and appropriately rejected 5303 of 5383 (Amland and Hahn-Cover, 2019). The positive results revealed, "the cloud-based sepsis CDS integrated with enterprise EHR systems is an effective approach toward early recognition of sepsis in a hospital setting" (Amland and Hahn-Cover, 2019, p. 500). The sepsis CDS allows providers to accelerate diagnostic and therapeutic interventions and increase the chances of patient recovery (Amland and Hahn-Cover, 2019).

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As an intensive care unit (ICU) nurse, I encounter patients with sepsis or systemic inflammatory response syndrome (SIRS) on a daily basis. However, before my organization HCA Healthcare introduced the Sepsis Prediction and Optimization of Therapy (SPOT) system, our organization's response to patients with SIRS or sepsis was delayed. That delay was due to clinicians' inability to decipher all the early signs and symptoms of sepsis and intervene quickly.

Two years ago, our organization implemented the SPOT system. At first, there was resistance to the procedure and the time-sensitive notifications and interventions required by all participants of the SPOT process. The process is as follows: the telemetry technician receives updated vital signs and lab results from the patient's EHR. The telemetry technician then calls the patient's bedside nurse and the nurse has 25 minutes to notify the provider from the time of the SPOT detection. Finally, the provider must acknowledge the positive sepsis screen and possibly provide new orders. Resistance was primarily due to nurse's inability to call providers with timely early sepsis warnings, and then providers not giving new orders or assessing the patient in a timely manner.

Following the initial resistance, providers and nurses were given more education about the SPOT system, and acceptance of the program became more popular. The SPOT system is now fully integrated into HCA Healthcare's preventative measures and has reduced patient mortality.

The dangers of sepsis cannot be overstated. As an ICU nurse septic patients are the most challenging patients to keep in homeostasis because of the multiple organs that are failing simultaneously. These patients often have multiple intravenous drugs running such as antibiotics, vasopressors, and fluids. In addition, many of these patients are intubated due to low Glasgow Coma Scores (GCS), and some have severe renal failure leading to continuous renal replacement therapy (CRRT). Septic patients require more treatments, interventions, resources, and staff than any other ICU patient. The SPOT system has allowed patients in early SIRS or sepsis to avoid the deadly consequences of sepsis.

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HCA HEALTHCARE'S SPOT (SEPSIS PREDICTION AND OPTIMIZATION OF THERAPY) VIDEO

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HCA HEALTHCARE'S SPOT (SEPSIS PREDICTION AND OPTIMIZATION OF THERAPY) VIDEO

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HCA Healthcare’s SPOT (Sepsis Prediction and Optimization of Therapy)

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CONS OF AN EARLY SEPSIS RECOGNITION SYSTEM

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CONS OF AN EARLY SEPSIS RECOGNITION SYSTEM

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1. Resistance to the sepsis CDS program by providers and nurses could mean delayed diagnostic tests and treatments.
2. According to Amland and Hahn-Cover (2019), a sepsis CDS program can be, "difficult to design, build, and implement; it is also difficult to achieve broad and sustained adoption by providers" (p. 500).

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TEAM LEADER- Shon Chekenyere. The strengths of the team leader are empathy, learner, context, input, and ideation. These strengths are beneficial because the team leader is capable of listening to all the team members and articulate their ideas into a coherent vision. With strengths such as Learner and Input, the team lead will ensure the content collected is relevant and based on scientific evidence.

1. Carlee – Consistency. This team member would be able to draft a policy and procedure for a new sepsis recognition system.

2. Fernando – Focus. This team member would set goals and deadlines for the team in order to keep the project on track.

3. Matthew – Maximizer. This team member would enhance the team's performance and ensure the work is researched and executed accurately.

4. Sheila - Strategic. This team member would provide ideas and strategies when issues and problems arise in the planning and implementation phase of the project.

5. Carter – Communication. This team member would present the new policy and procedure to the education department, providers, bedside staff members, and all other ancillary staff members involved in the early detection program.

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Amland, R.C., & Hahn-Cover, K.E. (2019). Clinical decision support for early recognition of sepsis. American Journal of Medical quality : The Official Journal of the American College of Medical Quality, 34(5), 494–501. https://doi-org.ezproxy.uttyler.edu/10.1177/1062860619873225

HCA Healthcare (2020, May, 15). SPOT technology to prevent sepsis. https://hcahealthcare.com/care-like-no-other/stories/spot-technology-to-prevent-sepsis.dot

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PROS OF AN EARLY SEPSIS RECOGNITION SYSTEM

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PROS OF AN EARLY SEPSIS RECOGNITION SYSTEM

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1.  "The sepsis CDS enables providers to accelerate diagnostic and therapeutic interventions and offers transparency to hospital-wide care management, with an objective of reversing a patient’s sepsis syndrome to potentially avert serious complications such as organ system dysfunction and death" (Amland & Hahn-Cover, 2019, p. 500).
2. The sepsis CDS reduces patients' length of stay and therefore reducing the economic cost of an extended hospital stay due to complications of sepsis.
3. The sepsis CDS reduces provider and staff burn-out due to fewer patients in critical conditions and multiple organ failure.

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Title:  Clinical Decision Support for Early Recognition of Sepsis*

Written by:  Robert C. Amland, Ph.D., and Kristin E. Hahn-Cover, MD.

Publisher:  American Journal of Medical Quality, Volume 34, Issue 5, Pages 494-501.

Year of Publication: 2019

Link: https://doi.org/10.1177/1062860619873225