Case study: Harborview Medical Center's automated sepsis alert system

Sepsis mortality rates increase quickly when left untreated, even if it’s only for a few hours. The difficulty facing providers is that there isn’t a simple test for sepsis. Instead, they have to watch for patterns and symptoms that could indicate sepsis. As a result, it’s common to have misdiagnoses or delays in diagnosis.

Sepsis is also the most fatal complication for burn victims, accounting for 50%–60% of burn injury deaths. That last issue is a particular concern for places like Harborview Medical Center in Seattle. The facility is the only designated Level I trauma and burn center in Washington state and is the regional trauma and burn referral center for Alaska, Montana, and Idaho. The 413-bed facility has around 17,000 admissions, 259,000 clinic visits, and 59,000 emergency department visits annually.

Rosemary Grant, BSN, RN, CPHQ, is the sepsis coordinator at Harborview. She says her facility chose to focus their attention on sepsis detection because the condition is “prevalent, expensive, and deadly.”

“When we looked at data from our hospital and others, we saw that patients who develop sepsis in the hospital have a much higher mortality than patients who arrive in the emergency department with sepsis,” says Grant. “So, we knew we needed to focus on faster identification of sepsis in our inpatient population.”

The evidence backs up her concerns. A 2017 study found that while sepsis is only present in 6% of hospitalizations, it accounts for 15% of in-hospital deaths. In 2014 alone, there were 1.7 million sepsis hospitalizations and 270,000 sepsis deaths in the U.S. It’s also one of the most expensive medical conditions, costing tens of billions of dollars annually. And sadly, despite increased awareness of the condition, mortality rates are rising.

In 2011, the Harborview team decided to fight sepsis by changing the way they detected it. Working in-house, they developed an automated flagging system for their electronic health record (EHR).

After a patient is admitted to Harborview, his or her vitals are plugged into the EHR several times each day. The system searches for patterns, trends, and symptoms that might indicate sepsis. If found, a red box appears around the patient’s name and the nurse is assigned a task in the EHR to screen the patient for infection.

The nurse then assesses the patient for non-sepsis causes for the readings. If the nurse thinks the patient could have sepsis, then the physician is alerted. The system is designed so it won’t sound more than once every 12 hours, she says, so nurses won’t get more than one alert per patient per shift.

“I think the most important component of our system is that it incorporates the bedside nurses’ clinical judgment,” says Grant. “The alert is just a computer algorithm, and if it paged the provider every time, they would become tired of it very quickly. Instead, it asks the nurse who is spending his/her shift with a patient whether infection is suspected based on abnormal vitals and the patient’s overall clinical picture. It’s only if and when the nurse suspects infection that the provider is notified.”

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