In in-patient facilities, how does the use of EHR
based alert systems compared to those without these
systems affect patient outcomes?
Shannon Albright, Alex Brown, Emily Carney, Maura Elliot, Andie Gillem, Emma Koenig
Background
Sepsis is a life threatening infection that affects millions every year and if not
treated early can spiral into severe conditions, including organ failure and
death. Sepsis is often overlooked and is often not seen as a medical
emergency until it is too late for the patient. In 2002, the Surviving Sepsis
Campaign was implemented to help nurses, doctors, and the rest of the
interdisciplinary team screen for sepsis and severe sepsis in order to treat and
prevent septic shock and multiple organ dysfunction syndrome. With the use of
systemic inflammatory response syndrome criteria nurses can be alerted with
two or more criteria met in order to recognize early symptoms of sepsis. The
electronic health alert system is a key component in alerting the care team
about skewed assessments, vitals, or labs drawn from the patient and can be
the determinant in early sepsis recognition. The use of early recognition of
sepsis can help the patient’s care team provide care, treatment, and control of
the infection present in body. Therefore, the use of electronic health record
(EHR) alerts for high risk patients has the potential to help reduce further harm
and provide early treatment for those at risk for sepsis.
Purpose
The purpose of this research study was to examine the link between EHR
based sepsis alerts and patient outcomes in the inpatient hospital setting. The
majority of nurses have been educated based off of The Surviving Sepsis
Campaign, which establishes a set of rules and guidelines regarding the
identification of sepsis and priority actions following diagnosis. However, that
may not be the most efficient way to identify sepsis in a timely matter. Our
research sought to analyze previous studies done in order to asses
whether EHR alert systems improve patient outcomes such as early
intervention and decreased patient mortality.
Table 1. SIRS and sepsis criteria
Figure 1. Sepsis word bubble.
Methods
The method used to collect data for this study was an article review. All articles
were pulled from the CINAHL database. The keywords used to search the
database were sepsis, electronic health record, and sepsis alert. To be
included in the data, an article had to be peer reviewed, published within the
the past 10 years, and published in English, and focus on the population of
adult inpatients. Articles were excluded if they did not focus on the adult
inpatient population, did not pertain to the topic of sepsis electronic health
record alerts, were published later than 10 years ago, were an opinion based
article, and were not published in English. Following this criteria, 13 research
articles were reviewed and their results compiled in order to examine a
possible connection between electronic health record sepsis alerts and
improved patient outcomes and nurse satisfaction of these alerts.
Results
• Of the 270 patients in the sample, 70.8% had received early
interventions for sepsis, versus 55.8% on the unit without the sepsis
screening system (Sawyer et al.).
• In a sample of 7,388 patients an electronic sepsis alert surveillance
system decreased sepsis mortality by 53% (Manaktala, S., et. al.).
• Review of 3,917 patients showed significant reductions (OR 0.62, 95%
CI 0.39–0.99, p = 0.046) in the odds of death in the afterphase of
implementation of an EMR-sepsis alert system (Guirgis et. al).
• 50 tele-ICU nurses who used the sepsis alert system claimed it is
effective, efficient and usable. (Rincon, Manos, & Pierce).
• The system is highly specific and sensitive, as evidenced by the results
of 205 true positive and 15 false negatives of sepsis identification for the
220 patients identified to have severe sepsis or sepsis shock following
implementation of the EMR-sepsis alert system (Alsolamy et al).
Nursing Implications
• Thorough assessment
• Chart vitals and assessment in a timely fashion for early intervention
• Attentiveness to notifications displayed on EMR
• Calling the provider as soon as EMR alerts
• Customizing alarms to prevent alarm fatigue
• Continuous assessment of vitals once interventions begin