Hospitals are generally interested in detecting and treating sepsis. As a result of multiple quality measures, however, now they are deeply in love with detecting and treating sepsis. And this means: yet another alert in your electronic health record.
One of these alerts, created by the Cerner Corporation, is described in a recent publication in the American Journal of Medical Quality. Their cloud-based system analyzes patient data in real-time as it enters the EHR and matches the data against the SIRS criteria. Based on 6200 hospitalizations retrospectively reviewed, the alert fired for 817 (13%) of patients. Of these, 622 (76%) were either superfluous or erroneous, with the alert occurring either after the clinician had ordered antibiotics or in patients for whom no infection was suspected or treated. Of the remaining alerts occurring prior to action to treat or diagnose infection, most (89%) occurred in the Emergency Department, and a substantial number (34%) were erroneous.
Therefore, based on the authors’ presented data, 126 of 817 (15%) of SIRS alerts provided accurate, potentially valuable information. Unfortunately, another 80 patients in the hospitalized cohort received discharge diagnoses of sepsis despite never triggering the tool – meaning false negatives approach nearly 2/3rds the number of potentially useful true positives. And, finally, these data only describe patients requiring hospitalization – i.e., not including those discharged from the Emergency Department. We can only speculate regarding the number of alerts triggered on the diverse ED population not requiring hospitalization – every asthmatic, minor trauma, pancreatitis, etc.
The lead author proudly concludes their tool is “an effective approach toward early recognition of sepsis in a hospital setting.” Of course, the author, employed by Cerner, also declares he has no potential conflicts of interest regarding the publication in question.
So, if the definition of “effective” is lower than probably 10% utility, that is the performance you’re looking it with these SIRS-based tools. Considering, on one hand, the alert fatigue, and on the other hand, the number of additional interventions and unnecessary tests these sorts of alerts bludgeon physicians into – such unsophisticated SIRS alerts are almost certainly more harm than good.
“Clinical Decision Support for Early Recognition of Sepsis”
http://www.ncbi.nlm.nih.gov/pubmed/25385815