OBJECTIVE: To determine whether automated identification with physician notification of the systemic inflammatory response syndrome in medical intensive care unit patients expedites early administration of new antibiotics or improvement of other patient outcomes in patients with sepsis.
DESIGN: : A prospective randomized, controlled, single center study.
SETTING: Medical intensive care unit of an academic, tertiary care medical center.
PATIENTS: Four hundred forty-two consecutive patients admitted over a 4-month period who met modified systemic inflammatory response syndrome criteria in a medical intensive care unit.
INTERVENTION: Patients were randomized to monitoring by an electronic "Listening Application" to detect modified (systemic inflammatory response syndrome) criteria vs. usual care. The listening application notified physicians in real time when modified systemic inflammatory response syndrome criteria were detected, but did not provide management recommendations.
MEASUREMENTS AND MAIN RESULTS: The median time to new antibiotics was similar between the intervention and usual care groups when comparing among all patients (6.0 hr vs. 6.1 hr, p = .95), patients with sepsis (5.3 hr vs. 5.1 hr; p = .90), patients on antibiotics at enrollment (5.2 hr vs. 7.0 hr, p = .27), or patients not on antibiotics at enrollment (5.2 hr vs. 5.1 hr, p = .85). The amount of fluid administered following detection of modified systemic inflammatory response syndrome criteria was similar between groups whether comparing all patients or only patients who were hypotensive at enrollment. Other clinical outcomes including intensive care unit length of stay, hospital length of stay, and mortality were not shown to be different between patients in the intervention and control groups.
CONCLUSIONS: Realtime alerts of modified systemic inflammatory response syndrome criteria to physicians in one tertiary care medical intensive care unit were feasible and safe but did not influence measured therapeutic interventions for sepsis or significantly alter clinical outcomes.
The information is useful especially to those who design electronic processes of care and methods that promote adherence to current standards and protocols.
This is useful information as sepsis is a huge problem in healthcare. This article should alert practitioners that we need to be very vigilant in identifying any patient who is septic. Studies that look at the screening process when the patient comes to the ER need to be examined. A flow chart for the triage staff would be very helpful. Prompt treatment is essential.
This is an interesting approach likely applied to the wrong group of patients (as the authors recognize in their discussion). High-level staffing and monitoring in the ICU likely precludes the need for this type of system in the ICU setting but may prove to be valuable in the ER or ward setting for selected "at risk" patients. That approach will hopefully be explored in future studies.
Study shows either that electronics have not replaced the clinician, or that the SIRS criteria are non-specific enough that electronics or clinicians are equivalent. Keep watching your patients, robots have not replaced you yet.