Use of clinical decision support to improve compliance with the Surviving Sepsis Campaign

Background

Evidence suggests that early, timely and aggressive resuscitation for patients with septic shock can have a significant impact on both morbidity and mortality. However, even with the widespread awareness of the Surviving Sepsis Campaign (SSC) guidelines, adherence varies widely. It has been shown that clinical decision support systems can help clinicians improve various aspects of clinical practice, particularly when they are integrated into clinical practice and present at the point of care. Protocol Watch (PW) was developed as a bedside tool to assist clinicians with both implementation of and compliance with the SSC guidelines. The purpose of this research was to measure the impact that using PW had on adherence to the SSC guidelines.

Methods

Participants were critically ill patients in two large university-affiliated teaching hospital intensive care units in the United States. Prior to the installation of PW, implementation of the SSC guidelines was done using a paper-based system of standing orders. Baseline data on compliance with the SSC guidelines were collected. PW, which offers an electronic version of the guidelines and is resident on the bedside patient monitor, was then installed in all critical care beds. The post PW installation data collection is currently being collected.

Results

Preliminary results show improvements in compliance with the resuscitation bundle, improved compliance with antibiotic administration, and a decreased time for completion of the resuscitation and management bundles and antibiotic administration (see Table 1). In addition, the feedback from the clinical users has been extremely positive.

Table 1 Mean values for age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, resuscitation/management bundle completion and antibiotic administration for initial subjects

Conclusion

If the final data analysis supports the preliminary findings, PW could emerge as an important method for assisting in the implementation of the SSC guidelines, thus making a valuable contribution in the care of critically ill patients with sepsis.