Can information technology improve guideline adherence in sepsis care?

A real-time monitoring and alerting system increased the delivery of guideline-recommended care for patients with suspected sepsis who were at risk for non-adherent care. The study did not, however, provide a signal that suggested that all-cause mortality could be improved following this intervention. 

“The Surviving Sepsis Campaign (SSC) guidelines and Center for Medicare and Medicaid Services (CMS) regulations recommend a bundle of interventions within 3 to 6 hours of sepsis recognition,” said Dr Daniel Leisman (Massachusetts General Hospital, MA, USA) [1]. “However, adherence to these recommendations remains low.” Dr Leisman evaluated whether real-time monitoring and automatic alerts may improve adherence to guideline interventions in patients with suspected sepsis who were at risk for non-adherent care. The included patients (n=1,377) were randomised to the intervention arm, in which an automated reminder page was sent to the physician if a 3-hour bundle element was not completed within 1 hour of the guideline time limit, or to the control group, in which the physicians did not receive automated alerts. 

Clinicians ordered a significantly higher number of guideline-directed interventions for patients in the intervention arm than for patients in the control arm (adjusted OR 1.56; 95% CI 1.22–1.99; P=0.0004). As a result, more guideline-adherent care was delivered to patients in the intervention arm (adjusted OR 1.42; P=0.0099). However, there was no significant difference between the 2 study groups concerning mortality at day 28, ICU admissions, or the need for mechanical ventilation. 

“Although the alerting system appeared to increase guideline-adherent care delivery in patients with suspected sepsis, this did not lead to a clear reduction in mortality,” summarised Dr Leisman. “The high proportion of patients who discontinued antibiotic treatment early, or had negative cultures, highlights the difficulty in selecting the appropriate patients for sepsis bundle applications.” 

1. Leisman DE, et al. Effect of automated real-time feedback on early sepsis care: a pragmatic trial. C94, ATS International Conference 2023, 19–24 May, Washington DC, USA. 

 

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Posted on 12 June, 202313 June, 2023