Clinical decision support tool helps reduce mortality in patients with severe sepsis
Implementation of an automated tool designed to support adherence to guidelines and promote optimal decision making and antibiotic use resulted in significantly reduced mortality in patients with severe sepsis, according to findings presented at the Society for Healthcare Epidemiology of America spring conference.
ILÚM Health Solutions’ clinical decision support solution (CDSS) uses data within the electronic health care record and notifies hospital staff of early signs of sepsis and severe sepsis and when there are discrepancies in adherence to treatment guidelines.
Jeanne Gorrondona, RN, BSN, infection control supervisor at East Jefferson General Hospital, and colleagues teamed with researchers at ILÚM Health Solutions, part of Merck Healthcare Services and Solutions, for a pilot study to assess the impact of the CDSS on sepsis management in the 424-bed general medical and surgical hospital. The researchers compared data from 12 months prior to implementing the CDSS (May 2014 to April 2015) with data from 12 months after implementation (September 2015 to August 2016).
The analysis included 151 patients with severe sepsis who were treated after CDSS was implemented and 56 controls. The researchers reported that implementation of the automated CDSS increased adherence to guideline-based care, including timely antibiotic ordering, serum lactic acid measurements and IV fluid administration in patients with hypotension or elevated serum lactic acid. By the end of the observation period, guideline adherence was 80% or higher for all metrics measured. In addition, there was a significant reduction in the all-cause (OR = 0.28; 95% CI, 0.11-0.74) and sepsis-related mortality rates (OR = 0.26; 95% CI, 0.09-0.74). The researchers also observed a declining trend in admission to the ICU and Cardiac/Coronary Care Unit, which was 57.1% before implementation and 45.7% after implementation (OR = 0.63; 95% CI, 0.32-1.22).
The researchers concluded that next steps will be to validate these positive findings in a larger prospective study.
Donna Carbajal RN, RRT, RRT-NPS, MBA, CJCP, senior director of quality and organizational effectiveness at East Jefferson General Hospital, told Infectious Disease News that the key to successful implementation of the CDSS is a multidisciplinary approach involving administration and medical leadership.
“Our goal is to use technology to help clinicians do their job better without interrupting their standard workflow,” she said. “ILÚM’s algorithm tied to a CDSS tool enabled us to adhere to evidence-based management guidelines and reduce mortality in patients with severe sepsis.” – by Stephanie Viguers
DePaula J, et al. A novel automated clinical decision support solution reduces mortality in patients with severe sepsis. Presented at: Society for Healthcare Epidemiology of America spring conference; March 29-31; St. Louis.
Disclosure: Carbajal reports no relevant financial disclosures. Infectious Disease News was unable to confirm Gorrondona’s disclosures at the time of publication.