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bioRxiv · 10.1101/637967

Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data

Honeyford, K.·Cooke, G.·Kinderlerer, A.·Williamson, E.·Gilchrist, M.·Holmes, A.·Glampson, B.·Mulla, A.·Costelloe, C.
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Abstract

ObjectiveTo determine the impact of a digital sepsis alert on patient outcomes in a UK multi-site hospital network.\n\nMethodsA natural experiment utlising the phased introduction of a digital sepsis alert into a multi-site hospital network. Sepsis alerts were either visible to clinicans (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 patient outcomes.\n\nOutcomes: In-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.\n\nResultsThe introduction of the alert was associated with lower odds of death (OR:0.76; 95%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).\n\nDiscussionCurrent 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, which may suggest a causal pathway. 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.\n\nConclusionsThese findings strongly suggest that the 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.\n\nFundingImperial NIHR Biomedical Research Centre: NIHR-BRC-P68711.

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Honeyford, K., Cooke, G., Kinderlerer, A., Williamson, E., Gilchrist, M., Holmes, A., Glampson, B., Mulla, A., Costelloe, C.. 2019-05-17. Evaluating a digital sepsis alert in a London multi-site hospital network: a natural experiment using electronic health record data. https://doi.org/10.1101/637967

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