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We set out to overcome barriers previously shown to impede sepsis therapy. Application of a universally standardized therapy model is an ongoing controversy. By taking advantage of the novel and adaptable aspects of a new technology, we predict that the introduction of an electronic health record based sepsis identification tool in the emergency department will aid clinicians in earlier implementation of sepsis directed therapy, namely intravenous fluids and antibiotics. A retrospective cohort study of 3,076 patients with the diagnosis of sepsis was performed. Patient charts were identified for this study who met the criteria of: ≥ 18 years old; emergency department evaluation; ICD-9 code of sepsis, severe sepsis, or septic shock. Data was divided into two treatment groups, preand post-best practice advisory (BPA) sepsis identification tool. Our primary outcome was time to intravenous fluids and time to antibiotics administration. The secondary outcome of in-patient all-cause mortality was measured. 1,266 patients were treated prior to, and 1,810 treated after, the BPA implementation with a decrease in time to intravenous fluids from 34% to 49.9% of patient receiving treatment in the first 60 min of emergency department arrival (difference of 15.9%; P < 0.05). The time to administration of antibiotics in the first 180 min of arrival improved from 40.3% to 56.8% (difference of 16.5%; P < 0.05). Secondarily, we found that in-patient mortality improved from 10.5% to 7.5%, preand post BPA respectively (difference of 3%; P < 0.05). Our study has demonstrated that the implementation of an active electronic health record screen tool that alerts clinicians to the possibility of sepsis may improve the time to initiate fluid blouses and antibiotics, and may lead to improved outcomes.

Earlier IV Fluid and Antibiotic Administration with an ED Electronic Sepsis Screening Tool