Analysis shows alert systems are ‘valuable tools’ to reduce sepsis-related death

Key takeaways:

• ED use of electronic sepsis alert systems significantly reduced sepsis-related mortality.
• Alert systems improved adherence to guidelines designed to improve outcomes among those with sepsis.

Adults treated in EDs with established sepsis alert systems benefited from reduced mortality risk and length of hospitalization compared with facilities with no alert system, according to data published in JAMA Network Open.

Results from a meta-analysis also showed that facilities with alert systems are more likely to adhere to evidence-based guidance developed by the Surviving Sepsis Campaign to help improve the quality of sepis care.

According to the CDC, sepsis contributes to 1.7 million adult hospitalizations annually and is the third-leading cause of death in hospitals in the United States.

“Timely diagnosis and treatment of sepsis are critical, as delays can significantly increase the risk of mortality and morbidity,” Hyung-Jun Kim, MD, from the department of internal medicine at Seoul National University Bundang Hospital in South Korea, and colleagues wrote.

They explained that sepsis alert systems are a potential solution to identifying sepsis early in overcrowded EDs, but little is known about their impact on patient and management outcomes.

Researchers conducted a systematic review and meta-analysis of studies evaluating electronic and nonelectronic sepsis alert systems to determine these systems’ effects on mortality, hospitalization, ICU admissions and adherence to the Surviving Sepsis Campaign guidelines.

The guidelines — a bundle of five evidence-based best practices that should be implemented within the first few hours of recognizing sepsis — “include fluid resuscitation with 30 mL/kg of crystalloid, blood culture before antibiotic administration, broad-spectrum antibiotic therapy, lactate measurement, and vasopressor support for refractory hypotension,” Kim and colleagues wrote.

Overall, 3,281 studies from several databases were initially identified, with 22 studies (n = 19,580) meeting the criteria for inclusion.

Results showed that implementation of any sepsis alert system reduced risk for mortality (RR = 0.81; 95% CI, 0.71-0.91) and length of hospitalization (standardized mean difference [SMD] = 0.15; 95% CI, 0.2 to 0.11).

EDs with alert systems also demonstrated better adherence to elements of the Surviving Sepsis Campaign guidelines, including earlier time to:

• fluid administration (SMD = 0.42; 95% CI, 0.52 to 0.32);
• blood culture (SMD = 0.31; 95% CI, 0.4 to 0.21);
• antibiotic administration (SMD = 0.34; 95% CI, 0.39 to 0.29); and
• lactate measurement (SMD = 0.15; 95% CI, 0.22 to 0.08).

Specifically, researchers observed an association between electronic alert systems and reduced mortality (RR = 0.78; 95% CI, 0.67 to 0.92) and greater adherence with blood culture guidelines (RR = 1.14; 95% CI, 1.03 to 1.27), “whereas the nonelectronic alert systems showed no notable difference,” Kim and colleagues wrote.

“The electronic alert system is integrated into the [electronic health record] and uses the information from the EHR to quickly alert clinicians to patients with sepsis, thereby improving their bundle adherence and reducing patient mortality rates,” they explained.

The researchers highlighted some study caveats. For example, the definition of sepsis was not consistent across all the included studies, whereas effects on vasopressor use could not be determined.

They also pointed out that further research on false-positive alarms, which substantially vary depending on the system method used, is warranted.

Despite these limitations, the results “highlight the potential of sepsis alert systems as valuable tools for improving the outcomes of adult patients with sepsis in the ED, thus emphasizing the importance of their widespread implementation and integration into clinical practice,” Kim and colleagues concluded.

References:

• Kim H, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.22823.
• Sepsis is the third leading cause of death in U.S. hospitals. But quick action can save lives. Available at: https://www.aamc.org/news/sepsis-third-leading-cause-death-us-hospitals-quick-action-can-save-lives. Published Oct. 10, 2023. Accessed July 24, 2024.