Effect of an electronic medical record alert for severe sepsis among ED patients

Am J Emerg Med. 2016 Feb;34(2):185-8. doi: 10.1016/j.ajem.2015.10.005. Epub 2015 Oct 14.


Background: Severe sepsis and septic shock are a major health concern worldwide. The objective of this study is to determine if Severe Sepsis Best Practice Alert (SS-BPA) implementation was associated with improved processes of care and clinical outcomes among patients with severe sepsis or septic shock presenting to the emergency department (ED).

Methods: This is a single-center, before-and-after observational study. The intervention group (n = 103) consisted of adult patients presenting to the ED with severe sepsis or septic shock during a 7-month period after implementation of the SS-BPA. The control group (n = 111) consisted of patients meeting the same criteria over a prior 7-month period. The SS-BPA primarily acts by automated, real-time, algorithm-based detection of severe sepsis or septic shock via the electronic medical record system. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), time to antibiotic administration, and proportion of patients who received antibiotics within the target 60 minutes.

Results: Time to antibiotics was significantly reduced in the SS-BPA cohort (29 vs 61.5 minutes, P < .001). In addition, there was a higher proportion of patients who received antibiotics within 60 minutes (76.7 vs 48.6%; P < .001). On multivariable analysis, in-hospital mortality was not significantly reduced in the intervention group (odds ratio, 0.64; 95% confidence interval, 0.26-1.57). Multivariable analysis of LOS indicated a significant reduction among patients in the SS-BPA cohort (geometric mean ratio, 0.66; 95% confidence interval, 0.53-0.82).

Conclusion: Implementation of the SS-BPA for severe sepsis or septic shock among ED patients is associated with significantly improved timeliness of antibiotic administration and reduced hospital LOS.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Algorithms
  • Anti-Bacterial Agents / therapeutic use
  • Clinical Protocols*
  • Electronic Health Records*
  • Emergency Service, Hospital*
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Outcome and Process Assessment, Health Care*
  • Sepsis / mortality
  • Sepsis / therapy*
  • Time Factors


  • Anti-Bacterial Agents