Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data. (20th November 2019)

• Record Type: Journal Article
• Authors: Honeyford, Kate; Cooke, Graham S; Kinderlerer, Anne; Williamson, Elizabeth; Gilchrist, Mark; Holmes, Alison; Glampson, Ben; Mulla, Abdulrahim; Costelloe, Ceire
• Is Part Of: Journal of the American Medical Informatics Association. Volume 27:Number 2(2020)
• Page Start: 274
• Page End: 283
• Publication Date: 2019-11-20
• Subjects: digital health -- electronic health record -- sepsis -- critical care -- alerts -- early warning scores; Medical informatics -- Periodicals; Information Services -- Periodicals; Medical Informatics -- Periodicals; Médecine -- Informatique -- Périodiques; Informatica; Geneeskunde; Informatique médicale; Computer network resources; Electronic journals; 610.285
• DOI: 10.1093/jamia/ocz186
• Languages: English
• ISSNs: 1067-5027

Abstract

Abstract: Objective: The study sought to determine the impact of a digital sepsis alert on patient outcomes in a UK multisite hospital network. Materials and Methods: A natural experiment utilizing the phased introduction (without randomization) of a digital sepsis alert into a multisite hospital network. Sepsis alerts were either visible to clinicians (patients in the intervention group) or running silently and not visible (the control group). Inverse probability of treatment-weighted multivariable logistic regression was used to estimate the effect of the intervention on individual patient outcomes. Outcomes: In-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the emergency department. Results: The introduction of the alert was associated with lower odds of death (odds ratio, 0.76; 95% confidence interval [CI], 0.70-0.84; n = 21 183), lower odds of prolonged hospital stay ≥7 days (OR, 0.93; 95% CI, 0.88-0.99; n = 9988), and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR, 1.71; 95% CI, 1.57-1.87; n = 4622). Discussion: Current evidence that digital sepsis alerts are effective is mixed. In this large UK study, a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics. It is not known whether the presence of alerting is responsible for improved outcomes or whether the alert acted as a useful driver for quality improvement initiatives. Conclusions: These findings strongly suggest that the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.