A real-time monitoring and alerting system increased delivery of guideline-recommended care for patients with suspected sepsis but did not affect mortality.
Daniel Leisman, MD
“The Surviving Sepsis Campaign guidelines and Centers for Medicare & Medicaid Services regulations recommend a bundle of interventions within 3 to 6 hours of sepsis recognition,” said Daniel Leisman, MD. “However, adherence to these recommendations remains low.” In his presentation at the 2023 American Thoracic Society International Conference, held from May 19-24, in Washington, DC, Dr. Leisman discussed his study of whether real-time monitoring and automatic alerts may improve adherence to guideline interventions in patients with suspected sepsis who are at risk for nonadherent care. The study randomly assigned 1,377 patients to a control arm or an intervention arm, in which an automated reminder page was sent to physicians if a 3-hour bundle element was not completed within 1 hour of the guideline time limit. In the control arm, physicians did not receive automated alerts.
Clinicians ordered a significantly higher number of guideline-directed interventions for patients in the intervention group than for patients in the control arm (adjusted OR, 1.56; 95% CI, 1.22-1.99; P=0.0004). As a result, more guideline-adherent care was delivered to patients in the intervention arm (adjusted OR, 1.42; P=0.0099). However, there was no significant difference between the two groups concerning mortality at day 28, ICU admissions, or the need for mechanical ventilation.
“Although the alerting system appeared to increase guideline-adherent care delivery in patients with suspected sepsis, this did not lead to a clear reduction in mortality,” summarized Dr. Leisman. “The high proportion of patients who discontinued antibiotic treatment early, or had negative cultures, highlights the difficulty in selecting the appropriate patients for sepsis bundle applications.”
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