Sooner is better: use of a real-time automated bedside dashboard improves sepsis care

J Surg Res. 2018 Nov:231:373-379. doi: 10.1016/j.jss.2018.05.078. Epub 2018 Jun 29.

Abstract

Background: Minimizing the interval between diagnosis of sepsis and administration of antibiotics improves patient outcomes. We hypothesized that a commercially available bedside clinical surveillance visualization system (BSV) would hasten antibiotic administration and decrease length of stay (LOS) in surgical intensive care unit (SICU) patients.

Methods: A BSV, integrated with the electronic medical record and displayed at bedside, was implemented in our SICU in July 2016. A visual sepsis screen score (SSS) was added in July 2017. All patients admitted to SICU beds with bedside displays equipped with a BSV were analyzed to determine mean SSS, maximum SSS, time from positive SSS to antibiotic administration, SICU LOS, and mortality.

Results: During the study period, 232 patients were admitted to beds equipped with the clinical surveillance visualization system. Thirty patients demonstrated positive SSS followed by confirmed sepsis (23 Pre-SSS versus 7 Post-SSS). Mean and maximum SSS were similar. Time from positive SSS to antibiotic administration was decreased in patients with a visual SSS (55.3 ± 15.5 h versus 16.2 ± 9.2 h; P < 0.05). ICU and hospital LOS was also decreased (P < 0.01).

Conclusions: Implementation of a visual SSS into a BSV led to a decreased time interval between the positive SSS and administration of antibiotics and was associated with shorter SICU and hospital LOS. Integration of a visual decision support system may help providers adhere to Surviving Sepsis Guidelines.

Keywords: Antibiotic treatment; Clinical decision support tools; Guideline compliance; Sepsis; Sepsis screening score; Septic shock.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Cohort Studies
  • Computer Systems*
  • Critical Care / methods*
  • Critical Care / standards
  • Decision Support Systems, Clinical*
  • Female
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Point-of-Care Testing*
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / mortality
  • Practice Guidelines as Topic
  • Quality Improvement / statistics & numerical data*
  • Sepsis / diagnosis*
  • Sepsis / drug therapy
  • Sepsis / etiology
  • Sepsis / mortality
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents