An electronic warning system helps reduce the time to diagnosis of sepsis

• Published in: Revista Brasileira de terapia intensiva Vol. 30; no. 4; pp. 414 - 422
• Main Authors: Westphal, Glauco Adrieno, Pereira, Aline Braz, Fachin, Silvia Maria, Sperotto, Geonice, Gonçalves, Maurício, Albino, Lucimeri, Bittencourt, Rodolfo, Franzini, Vanessa de Rossi, Koenig, Álvaro
• Format: Journal Article
• Language: Portuguese; English
• Published: Brazil Associação de Medicina Intensiva Brasileira - AMIB 2018
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Cohort Studies; Female; Humans; Male; Original; Practice Guidelines as Topic; Sepsis - diagnosis; Sepsis - drug therapy; Sepsis - mortality; Telephone; Time Factors; Triage - methods
• ISSN: 0103-507X; 1982-4335
• DOI: 10.5935/0103-507X.20180059

To describe the improvements of an early warning system for the identification of septic patients on the time to diagnosis, antibiotic delivery, and mortality. This was an observational cohort study that describes the successive improvements made over a period of 10 years using an early warning system to detect sepsis, including systematic active manual surveillance, electronic alerts via a telephonist, and alerts sent directly to the mobile devices of nurses. For all periods, after an alert was triggered, early treatment was instituted according to the institutional sepsis guidelines. In total, 637 patients with sepsis were detected over the study period. The median triage-to-diagnosis time was reduced from 19:20 (9:10 - 38:15) hours to 12:40 (2:50 - 23:45) hours when the manual surveillance method was used (p = 0.14), to 2:10 (1:25 - 2:20) hours when the alert was sent automatically to the hospital telephone service (p = 0.014), and to 1:00 (0:30 - 1:10) hour when the alert was sent directly to the nurse's mobile phone (p = 0.016). The diagnosis-to-antibiotic time was reduced to 1:00 (0:55 - 1:30) hours when the alert was sent to the telephonist and to 0:45 (0:30 - 1:00) minutes when the alert was sent directly to the nurse's mobile phone (p = 0.02), with the maintenance of similar values over the following years. There was no difference in the time of treatment between survivors and non-survivors. Electronic systems help reduce the triage-to-diagnosis time and diagnosis-to-antibiotic time in patients with sepsis.