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Crit Care Med. 2015 Aug;43(8):1595-602. doi: 10.1097/CCM.0000000000001020.

An Electronic Tool for the Evaluation and Treatment of Sepsis in the ICU: A Randomized Controlled Trial.

Author information

1
1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN. 2Division of Anesthesiology Critical Care Medicine, Vanderbilt University, Nashville, TN. 3Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA. 4Division of Critical Care, Christian Medical College Hospital, Vellore, Tamil Nadu, India. 5Institute for Software Integrated Systems, Vanderbilt University School of Engineering, Nashville, TN. 6Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN. 7Department of Internal Medicine, Meharry Medical College, Nashville, TN.

Abstract

OBJECTIVES:

To determine whether addition of an electronic sepsis evaluation and management tool to electronic sepsis alerting improves compliance with treatment guidelines and clinical outcomes in septic ICU patients.

DESIGN:

A pragmatic randomized trial.

SETTING:

Medical and surgical ICUs of an academic, tertiary care medical center.

PATIENTS:

Four hundred and seven patients admitted during a 4-month period to the medical or surgical ICU with a diagnosis of sepsis established at the time of admission or in response to an electronic sepsis alert.

INTERVENTIONS:

Patients were randomized to usual care or the availability of an electronic tool capable of importing, synthesizing, and displaying sepsis-related data from the medical record, using logic rules to offer individualized evaluations of sepsis severity and response to therapy, informing users about evidence-based guidelines, and facilitating rapid order entry.

MEASUREMENTS AND MAIN RESULTS:

There was no difference between the electronic tool (218 patients) and usual care (189 patients) with regard to the primary outcome of time to completion of all indicated Surviving Sepsis Campaign 6-hour Sepsis Resuscitation Bundle elements (hazard ratio, 1.98; 95% CI, 0.75-5.20; p = 0.159) or time to completion of each element individually. ICU mortality, ICU-free days, and ventilator-free days did not differ between intervention and control. Providers used the tool to enter orders in only 28% of available cases.

CONCLUSIONS:

A comprehensive electronic sepsis evaluation and management tool is feasible and safe but did not influence guideline compliance or clinical outcomes, perhaps due to low utilization.

PMID:
25867906
PMCID:
PMC4506222
DOI:
10.1097/CCM.0000000000001020
[Indexed for MEDLINE]
Free PMC Article

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