Introduction: Early recognition and response to sepsis is a key link in the sepsis chain of survival. Early warning systems lack high reliability to identify patients with possible sepsis. False alarms and alert fatigue impact healthcare. We explored a novel approach to rapidly identify and evaluate patients for possible sepsis through screening of a proprietary alert combined with triage integration with a Virtual ICU Nurse (VICU RN). Methods: VICU RN initiated a rapid clinical review of Electronic Health Record (EHR) after receiving an Epic Early Detection of Sepsis Alert Version 2 from Acute Care Unit and Emergency Department patients. Assessment included review for signs and symptoms suggestive of sepsis using a protocolized approach. All screens were documented in the EHR. When concerning findings were present, the VICU RN would collaborate with the patient’s Clinical RN for further evaluation. For confirmed positive screens (suspected sepsis) the VICU and Clinical RN would collaborate to initiate the sepsis protocol, provide support to the clinical teams, or escalate care. Results: Over a 4-month timeframe, VICU RNs had responded to 5600 sepsis alert pages. This encompassed 2832 patients. There was an average of 2.1 alerts per patient. 321 alerts (5.7%) resulted in escalations from the VICU RN to the Clinical Nurse to evaluate concerns for sepsis further, while the remaining (94.3%) of alerts were only evaluated by the VICU RN. In 170 of those cases (52%), the VICU RN provided intervention recommendations. Most frequent recommendations: draw lactate, draw blood culture, and re-assessment plan. Escalation from the VICU RN to the VICU Physician averaged one per day. Survey data at end of 90-days was obtained from VICU RNs and conveyed themes of improved communication, support, and response. The short duration of the pilot did not provide adequate data for process and outcome evaluation. Conclusions: This pilot demonstrated value of experienced VICU RNs augmenting automated alerts. Use of the VICU RNs clinical expertise and judgement led to rapid recognition and response to cases of suspected sepsis without burdening clinical teams with false alerts. This alert triage and escalation system for suspected sepsis demonstrated positive qualitative impact on communication, support, and improved response.
Sherry et al. (Sun,) studied this question.