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Digital monitoring system helps improve hospital care of sepsis patients

Monitoring system reduced deaths, hospital stay and increased timely use of antibiotics in sepsis patients

Ingrid Torjesen

Wednesday, 20 November 2019

A digital alert system to monitor patients with sepsis has led to a reduction in deaths and hospital stays, and improved timely use of antibiotics during a trial at Imperial College Healthcare NHS Trust, a study* published in the Journal of the American Medical Informatics Association has shown.

The system monitors a range of changes in patients such as temperature, heart rate and glucose levels and alerts doctors and nurses if they fall outside safe parameters so they can investigate further. Clinicians are notified of patients who have triggered the alert either through a pop-up warning on their electronic health records and/or on a dashboard, which highlights any patient with an active alert when they open a patient's record.

In addition to the alert, Imperial College Healthcare NHS Trust designed a multidisciplinary care plan which is launched in the electronic patient record system when a clinician confirms a diagnosis of sepsis. This prompts the clinical team to determine the best options from a range of treatments, such as fluids, oxygen, diagnostic tests and early antibiotics, and ensure they are given to patients within one hour - in line with national targets.

The digital sepsis alert system was introduced at Imperial College Healthcare NHS Trust's hospitals in 2016 within emergency departments and inpatient wards. The team analysed data of more than 27,000 hospital stays of patients who had triggered the alert system between October 2016 and May 2018. These patients were in emergency departments as well as acute and haematology wards at St Mary's Hospital, Charing Cross Hospital and Hammersmith Hospital.

The team found that patients who triggered the alert had 24 per cent lower odds of in hospital death as well as a 35 per cent increased chance of receiving timely antibiotics than a group of patients who were receiving the usual standard care, where the digital alert system is not involved. They also found that patients who were admitted to hospital had a 4 per cent lower chance of staying in hospital for more than seven days than patients with similar symptoms, than the group of patients who were receiving standard care.

The team suggests the alert system has been able to alert clinicians to deteriorating conditions in patients and, as a result, investigations and treatment plans have been implemented more quickly.

The team will now carry out a larger study involving more NHS hospitals to see whether the results are the same in a bigger patient group.

Dr Kate Honeyford, from the Global Digital Health Unit at Imperial College London and lead author of the research, said: “Sepsis can be deadly if it's not diagnosed and treated quickly. However, symptoms can be hard to spot and are similar to other conditions such as flu or a chest infection, which can result in delayed diagnosis and treatments. The sepsis alert system was put in place at Imperial College Healthcare NHS Trust to see if it can help monitor and flag patients who may have sepsis to clinicians for further investigations and treatments. Often digital systems are implemented but research on their performance is not done. Our study shows for the first time that robust analysis of a digital alert system was associated with improvements in outcomes for patients and the system presents an opportunity to improve care for patients who may have sepsis."

*Honeyford K, Cooke GS, Kinderlerer A, et al. Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data. Journal of the American Medical Informatics Association. DOI:10.1093/jamia/ocz186

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