Sepsis Alert Systems in EDs Reduce Mortality

TOPLINE: 

Implementation of sepsis alert systems in emergency departments is associated with reduced mortality, shorter hospital stays, and improved adherence to sepsis management protocols.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of 22 studies involving 19,580 patients to assess the impact of sepsis alert systems in emergency departments on patient outcomes.
• Participants were divided into treatment groups (n = 10,344) and control groups (n = 9236) on the basis of implementation and non-implementation of sepsis alert systems, respectively.
• The outcomes evaluated included death, intensive care unit admission, hospital length of stay, and adherence to the Surviving Sepsis Campaign sepsis bundle (intravenous fluid administration, acquisition of blood culture, antibiotic administration, and lactate measurement).

TAKEAWAY:

• The overall mortality rate was 14%. Implementation of a sepsis alert system was associated with a 19% reduction in the risk for mortality (risk ratio [RR], 0.81; 95% CI, 0.71-0.91).
• Patients in the sepsis alert system group had a shorter hospital stay than those in the control group (standardized mean difference [SMD], −0.15; 95% CI, −0.20 to −0.11).
• Implementation of a sepsis alert system was associated with earlier administration of intravenous fluid (SMD, −0.42; 95% CI, −0.52 to −0.32), blood culture (SMD, −0.31; 95% CI, −0.40 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).
• Electronic alert systems were particularly effective, reducing mortality by 22% (RR, 0.78; 95% CI, 0.67-0.92) and improving adherence to blood culture guidelines by 14% (RR, 1.14; 95% CI, 1.03-1.27).

IN PRACTICE: 

“The results of this study highlight the potential of sepsis alert systems as valuable tools for improving the outcomes of adult patients with sepsis in the emergency department, thus emphasizing the importance of their widespread implementation and integration into clinical practice, ” the authors wrote.

SOURCE: 

The study was led by Hyung-Jun Kim, MD, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. It was published online on July 22, 2024, in JAMA Network Open.

LIMITATIONS: 

The definition of sepsis was not uniform across the included studies, which may affect the generalizability of the findings. Most studies were observational, which could have introduced biases. Additionally, most management protocols included steps for sepsis management after sepsis alert system interventions, potentially influencing clinical outcomes. The study lacked comprehensive data on the proportion of patients whose care adhered fully to all aspects of the sepsis bundle within the critical first hour of recognition.

DISCLOSURES: 

One author disclosed receiving grants from the Seoul National University Bundang Hospital research fund for the study. The authors did not disclose any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.