Early Identification of Severe Sepsis in Pediatric Patients Using an Electronic Alert System

Abstract

INTRODUCTION Prompt sepsis recognition and the initiation of standardized treatment bundles lead to improved outcomes. We developed automated severe sepsis alerts through the electronic medical record and paging system to aid clinicians in rapidly identifying pediatric patients with severe sepsis in our emergency department and inpatient units. Our Specific, Measurable, Applicable, Realistic, Timely aim was to improve 1-hour severe sepsis treatment bundle compliance to 60% with these electronic interruptive alerts. METHODS We developed the alert’s criteria based on the 2005 International Pediatric Sepsis Consensus definitions. We performed 2 interventions: requiring the bedside nurse to answer the already implemented nurse-targeted (NT) severe sepsis alert, and the implementation of the physician-targeted (PT) severe sepsis alert. When systemic inflammatory response syndrome criteria were met, the NT alert triggered, and when organ dysfunction was also identified, an interruptive PT alert triggered, and the respective clinician was paged to evaluate the patient. Our primary outcome measure was bundle compliance; our secondary measure was PT alert response compliance. RESULTS Baseline severe sepsis treatment bundle compliance was 37%. After requiring nursing response to the NT alert in 2016 and implementing the PT alert in 2018, our bundle compliance rose to 69% in 2020, demonstrating statistically significant difference (P = .006). PT alert response compliance rose from 67% in 2018 to 91% in 2020. CONCLUSIONS An interruptive severe sepsis screening alert sent directly to clinicians is a valuable tool to ensure prompt severe sepsis recognition and treatment. This biphasic alert system facilitated multidisciplinary collaboration in early sepsis diagnosis and management.