• J Am Med Inform Assoc · Feb 2020

    Evaluating a digital sepsis alert in a London multisite hospital network: a natural experiment using electronic health record data.

    • Kate Honeyford, Graham S Cooke, Anne Kinderlerer, Elizabeth Williamson, Mark Gilchrist, Alison Holmes, Sepsis Big Room, Ben Glampson, Abdulrahim Mulla, and Ceire Costelloe.
    • Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
    • J Am Med Inform Assoc. 2020 Feb 1; 27 (2): 274-283.

    ObjectiveThe study sought to determine the impact of a digital sepsis alert on patient outcomes in a UK multisite hospital network.Materials And MethodsA natural experiment utilizing the phased introduction (without randomization) of a digital sepsis alert into a multisite hospital network. Sepsis alerts were either visible to clinicians (patients in the intervention group) or running silently and not visible (the control group). Inverse probability of treatment-weighted multivariable logistic regression was used to estimate the effect of the intervention on individual patient outcomes.OutcomesIn-hospital 30-day mortality (all inpatients), prolonged hospital stay (≥7 days) and timely antibiotics (≤60 minutes of the alert) for patients who alerted in the emergency department.ResultsThe introduction of the alert was associated with lower odds of death (odds ratio, 0.76; 95% confidence interval [CI], 0.70-0.84; n = 21 183), lower odds of prolonged hospital stay ≥7 days (OR, 0.93; 95% CI, 0.88-0.99; n = 9988), and in patients who required antibiotics, an increased odds of receiving timely antibiotics (OR, 1.71; 95% CI, 1.57-1.87; n = 4622).DiscussionCurrent evidence that digital sepsis alerts are effective is mixed. In this large UK study, a digital sepsis alert has been shown to be associated with improved outcomes, including timely antibiotics. It is not known whether the presence of alerting is responsible for improved outcomes or whether the alert acted as a useful driver for quality improvement initiatives.ConclusionsThese findings strongly suggest that the introduction of a network-wide digital sepsis alert is associated with improvements in patient outcomes, demonstrating that digital based interventions can be successfully introduced and readily evaluated.© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.

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