Appl Clin Inform 2017; 08(01): 47-66
DOI: 10.4338/ACI-2016-07-RA-0112
Research Article
Schattauer GmbH

Secondary Analysis of an Electronic Surveillance System Combined with Multi-focal Interventions for Early Detection of Sepsis

Bonnie L. Westra
1  University of Minnesota, School of Nursing, Minneapolis, MN, USA 55455
,
Sean Landman
2  University of Minnesota, Department of Computer Science & Engineering, Minneapolis, MN, USA
,
Pranjul Yadav
2  University of Minnesota, Department of Computer Science & Engineering, Minneapolis, MN, USA
,
Michael Steinbach
2  University of Minnesota, Department of Computer Science & Engineering, Minneapolis, MN, USA
› Author Affiliations
FundingThis study was funded by Wolters Kluwer
Further Information

Correspondence to:

Bonnie L. Westra, PhD, RN, FAAN, FACMI
University of Minnesota, School of Nursing
308 Harvard St SE, WDH 5–140
Minneapolis, MN, USA 55455

Publication History

Received: 14 July 2016

Accepted: 11 January 2016

Publication Date:
20 December 2017 (online)

 

Summary

Summary: To conduct an independent secondary analysis of a multi-focal intervention for early detection of sepsis that included implementation of change management strategies, electronic surveil-lance for sepsis, and evidence based point of care alerting using the POC AdvisorTM application. Methods: Propensity score matching was used to select subsets of the cohorts with balanced covariates. Bootstrapping was performed to build distributions of the measured difference in rates/ means. The effect of the sepsis intervention was evaluated for all patients, and High and Low Risk subgroups for illness severity. A separate analysis was performed patients on the intervention and non-intervention units (without the electronic surveillance). Sensitivity, specificity, and the positive predictive values were calculated to evaluate the accuracy of the alerting system for detecting sepsis or severe sepsis/ septic shock.

Results: There was positive effect on the intervention units with sepsis electronic surveillance with an adjusted mortality rate of –6.6%. Mortality rates for non-intervention units also improved, but at a lower rate of –2.9%. Additional outcomes improved for patients on both intervention and non-intervention units for home discharge (7.5% vs 1.1%), total length of hospital stay (-0.9% vs –0.3%), and 30 day readmissions (-6.6% vs –1.6%). Patients on the intervention units showed better outcomes compared with non-intervention unit patients, and even more so for High Risk patients. The sensitivity was 95.2%, specificity of 82.0% and PPV of 50.6% for the electronic surveillance alerts. Conclusion: There was improvement over time across the hospital for patients on the intervention and non-intervention units with more improvement for sicker patients. Patients on intervention units with electronic surveillance have better outcomes; however, due to differences in exclusion criteria and types of units, further study is needed to draw a direct relationship between the electronic surveillance system and outcomes.


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Conflicts of interest

None of the listed authors have any financial or personal relationships with other people or organizations that may inappropriately influence or bias the objectivity of submitted content and /or its acceptance of publication in this journal.


Correspondence to:

Bonnie L. Westra, PhD, RN, FAAN, FACMI
University of Minnesota, School of Nursing
308 Harvard St SE, WDH 5–140
Minneapolis, MN, USA 55455