Sepsis is a medical emergency that can lead to tissue damage, organ failure
and even death. It is a complication of an existing infection left untreated
or not treated appropriately or in a timely fashion. Each year, sepsis
leads to death for a quarter of a million Americans and causes two percent
of all hospital admissions nationwide, according to the
Centers for Disease Control and Prevention (CDC). Anyone, anywhere can have an infection that becomes septic, but children,
senior adults and chronically ill individuals are most at risk.
Clinicians and computer analysts at North Oaks Health System have innovated
a tool that harnesses the power of
Epic’s electronic health record technology and predictive modeling to save lives
from sepsis. In just one year, the sepsis mortality rate at North Oaks
has dropped by nearly 18 percent compared with the previous year since
the implementation of this model, according to
Dr. Herbert Robinson, chief health information officer for North Oaks Health System.
“If left untreated, septic patients will die. So treatment must begin
within the first few hours of onset to offer the greatest chance of survival,”
Robinson explains. “That’s why from the time patients arrive
at our hospitals, we evaluate them carefully and then constantly monitor
their clinical course to detect any developing signs or symptoms of sepsis.
We do this so that appropriate and timely interventions can occur.”
The team at North Oaks is using a computerized tool, called a Clinical
Care Advisory (CCA), to help notify caregivers of patients at risk for
sepsis based on information in the patient’s medical record. The
CCA runs on a “predictive model" in the patient’s electronic
health record looking for signs and symptoms of sepsis.
“By embedding machine learning into the existing workflow, minutes
can be saved,” explains Seth Hain, Epic’s director of analytics
and machine learning. “As data flows into the chart, the algorithm
looks for patterns indicating the early onset of sepsis. Then the results
are put directly in front of clinicians, giving them the cue to intervene
earlier and help patients.”
Once a patient arrives in the
emergency room, the CCA sweeps the patient’s health information every 15 minutes,
monitoring more than 80 different data points, to generate a sepsis risk
score. If the patient’s score reaches a certain threshold, the clinicians
get a warning that the patient may be becoming septic. The patient is
then evaluated more closely, and the CCA recommends the best treatments
for sepsis. This process continues throughout the patient’s hospital
stay, allowing doctors and nurses to make decisions to implement life-saving
treatments at the earliest possible time.
“Patients are now receiving antibiotics about 25 percent faster —
or 30 minutes sooner — than they were before CCA. Combined with
the clinical expertise of our doctors and nurses, our approach is saving
lives,” Robinson affirms.
“Our goal is to make this new tool more accessible to community health
systems like North Oaks by ensuring the setup and statistical validation
are efficient and easy to use,” says Hain. “North Oaks was
able to set up the model quickly, allowing them to focus on the outcomes.”
The most frequently identified germs that cause infections that lead to
sepsis include staphylococcus, E. coli and some types of streptococcus,
according to the CDC. Symptoms can include one or any combination of the
- Confusion or disorientation
- Shortness of breath
- High heart rate
- Fever or shivering or feeling very cold
- Extreme pain or discomfort
- Clammy or sweaty skin.
Robinson encourages anyone who suspects sepsis or has an infection that’s
not getting better or is getting worse to seek immediate medical attention.