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Why an adjustable EPR is the best defense against sepsis

Sepsis exacts a devastating toll on human life, and the estimated costs for this disease are about US$17 billion in the United States alone.  But evidence suggests optimized electronic patient records (EPRs)* can make a real difference in the battle against sepsis and other hospital-acquired infections.

My personal prediction is that, because of our ability to detect patient deterioration, sepsis will eventually become another never event.

Fighting sepsis with computer power

Sepsis is a deadly and costly disease that arises when the body’s response to an infection damages its own tissue. Treatments are not benign and are astronomically expensive, hence clinicians are appropriately conservative in initiating treatment.

Sepsis is insidious. Clinicians know it might happen, but it’s hard to see all the factors contributing to it. In the past, we had to rely on smart clinicians, watching carefully to discern when a patient was about to “go septic.” Then they had to order the right labs to confirm their diagnosis and initiate immediate, aggressive treatment.

In our modern day and age we have another way. We can use computers for computing sepsis risk. We can detect patient deterioration using locally specific factors and avert, in many or most cases, sepsis. Worst case, we can detect sepsis early on, and initiate treatment early to minimize impact and cost.

The EPR can monitor patients in real time and assess important changes, and notify key clinicians to act quickly. This concept of alert-based monitoring of patient status is not new. We’ve had things like Early warning systems (EWS) and Medical Early Warnings (MEWs) for years.  However, the ability to achieve this early detection and alerting, leveraging locally relevant criteria that are programmed and refined locally IS new.

So now we have the option to program and customize EPRs by location. Our Sunrise platform has this capability, which is imperative for many reasons, including:

  • Targeting alerts to the right people. Who is the best clinician to respond to an alert? It’s different for different organizations. For some it’s the nurse, and for others it’s the attending physician. Still others prefer the rapid response team, or maybe all of the above. Providing locally relevant notifications reduces “alert fatigue” and improves clinician response.
  • Fine-tuning alerts for each population. In all fairness, no two acute care facilities have identical patient populations or community bugs. Some patient populations may be more susceptible to sepsis than others and some community bugs more virulent than others. Clinicians can modify alerts to suit these particular needs and optimal treatment alternatives, for example matching initial antibiotics to local microbes.
  • Keeping up with latest treatment regimens. Nobody knows what the best care model will be two years from now, or 10 years from now. So we need to be able to adjust our EPRs and treatment recommendations for clinicians.

How one organization reduced sepsis rates by 66%

By programming their EPRs to monitor each patient for changes in critical physiological factors, clinicians can now perceive deteriorating patients before they “go septic.” We can alert key clinicians so they can act efficaciously and avert disasters.

One specific organization I work with was able to reduce its sepsis rate by 66% over two years. The average cost per case for sepsis is open to debate. Estimates vary between US$7,000 and US$75,000 per case, reflecting the wide range of severity and comorbidities. But if we use a moderate estimate, that organization avoided more than $10 million in costs of sepsis care over two years.

Surely, we would like to eliminate all avoidable sepsis cases. Ideally clinicians can program, fine-tune and automate their EPRs for fast response. They should be able to readily adjust EPRs for new treatment approaches and protocols. Any organization that has to rely on the EPR vendor to provide this cannot effectively innovate or react to improvements in care models in time to avert disasters at the patient level.

Leveraging computing power inherent within advanced EPRs leads to better patient care, reduced costs, higher efficiencies and optimal clinical outcomes.

*Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

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