New Approaches to Reducing Sepsis Mortality and Morbidity

When it comes to reducing sepsis deaths, the key is rapid diagnosis and treatment. Numerous studies have established a link between delays in the administration of antibiotics and the odds of death. One study, in the Journal of Intensive Care Medicine, found that each hour that passed increased the odds of death by an additional 4 percent. Another, in Critical Care Medicine, found that each hour of delay from the onset of hypotension to the administration of antibiotics was associated with a 7.6 percent decrease in hospital survival.

Thus, it makes sense that anything that shortens the window of time between diagnosis and treatment will also decrease length of stay (LOS). A recent study in the Journal of Surgical Research set out to evaluate that hypothesis, looking specifically at a commercially available bedside clinical surveillance visualization system (BSV) used to monitor patients in a surgical intensive care unit (SICU) at the University of Cincinnati Medical Center.

The study, “Sooner is better: use of a real-time automated bedside dashboard improves sepsis care,” focused specifically on the impact of a BSV system in place at the medical center. Integrated with the center’s electronic health record (EHR) system, the surveillance system displayed the patient’s vital signs and laboratory values in real time on a dedicated monitor above the bed, where it was visible to physicians, nurses, the patient and family/loved ones. The display itself was color-coded from bright green for normal values up to bright red for critically abnormal values indicating the need for immediate intervention.

All patients admitted to SICU beds with the displays underwent an analysis to determine their mean and maximum sepsis screen score (SSS), time from positive SSS to antibiotic administration, LOS and mortality. The SSS values were displayed on the BSV monitor. In all, 232 patients were admitted to beds featuring the BSV, 30 of whom demonstrated positive SSS followed by confirmed sepsis.

While mean and maximum SSS were similar, the time elapsed from a positive SSS to antibiotic administration was much lower for patients with the SSS displayed on the monitor. SICU and hospital LOS also declined.

Researchers attributed the reduction in the time that elapsed between diagnosis and antibiotic administration to earlier identification of patients who exhibited signs and symptoms of sepsis, the timely initiation of a confirmatory sepsis work-up and, as a result, faster diagnosis. These findings led them to conclude that the BSV system’s ability to rapidly notify clinicians to possible sepsis led to more efficient initiation of sepsis bundles.

According to researchers, these findings are particularly relevant for large academic centers like the University of Cincinnati Medical Center, which “may provide more opportunity for uncoordinated process of care. At these institutions, the implementation of bedside display systems and clinical decision support tools can assist in early diagnosis of sepsis and septic shock. Thus, antibiotics can be administered sooner, and in-hospital survival can improve.”

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