Evaluation of an augmented emergency department electronic medical record-based sepsis alert

Emerg Med Australas. 2021 Oct;33(5):848-856. doi: 10.1111/1742-6723.13748. Epub 2021 Feb 23.

Abstract

Objective: Electronic medical records-based alerts have shown mixed results in identifying ED sepsis. Augmenting clinical patient-flagging with automated alert systems may improve sepsis screening. We evaluate the performance of a hybrid alert to identify patients in ED with sepsis or in-hospital secondary outcomes from infection.

Methods: We extracted a dataset of all patients with sepsis during the study period at five participating Western Sydney EDs. We evaluated the hybrid alert's performance for identifying patients with a discharge diagnosis related to infection and modified sequential sepsis-related organ functional assessment (mSOFA) score ≥2 in ED and also compared the alert to rapid bedside screening tools to identify patients with infection for secondary outcomes of all-cause in-hospital death and/or intensive care unit admission.

Results: A total of 118 178 adult patients presented to participating EDs during study period with 1546 patients meeting ED sepsis criteria. The hybrid alert had a sensitivity - 71.2% (95% confidence interval 68.8-73.4), specificity - 96.4% (95% confidence interval 96.3-96.5) for identifying ED sepsis. Clinician flagging identified additional alert-negative 232 ED sepsis and 63 patients with secondary outcomes and 112 alert-positive patients with infection and ED mSOFA score <2 went on to die in hospital.

Conclusion: The hybrid alert performed modestly in identifying ED sepsis and secondary outcomes from infection. Not all infected patients with a secondary outcome were identified by the alert or mSOFA score ≥2 threshold. Augmenting clinical practice with auto-alerts rather than pure automation should be considered as a potential for sepsis alerting until more reliable algorithms are available for safe use in clinical practice.

Keywords: algorithm; decision support system; emergency service; hospital; sepsis; systemic inflammatory response syndrome.

MeSH terms

  • Adult
  • Electronic Health Records*
  • Emergency Service, Hospital
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Retrospective Studies
  • Sepsis* / diagnosis