The clinical decision support system for sepsis as an important part of the medical and economic component of a hospital

Aim: To evaluate an impact of a clinical decision support system (CDSS) in the clinical practice of a hospital on the quality and costs of treatment of patients with severe sepsis and septic shock.Materials and methods: We performed a retrospective analysis of the database in the medical information system qMS (SP.ARM, Russia, St. Petersburg) from 2015 to 2017 on 37,997 patients. In the first study period from January 2015 to June 2016, we analyzed the results of the conventional treatment regimen. From May to June 2016, the CDSS module was implemented into the qMS and the personnel was trained correspondingly. The data collected during the second study period mirrored the results of sepsis treatment with the use of CDSS. We assessed the average number of in-hospital days, duration of stay in the intensive care unit, number of septic shock cases, mortality, and treatment costs.Results: The diagnosis of sepsis was confirmed in 67 patients: in 1.4‰ (27/18,792) before the CDSS was implemented versus 2.1‰ (40/19,205) after the CDSS implementation (p < 0.01). It was found that the use of CDSS integrated into the hospital medical information system reduced the number of cases of septic shock development (p < 0.05). Lethality decreased by 10%. The sepsis-associated mortality showed a non-significant trend to decrease by 10% (p < 0.1). The implementation of the CDSS incorporated into the qMS helped to reduce the number of septic shock cases from 26% (7/27) to 7.5% (3/40) (p < 0.05). There was also a trend towards reduced duration of stay in intensive care unit, as well as towards decreased costs of sepsis treatment by 13% and efferent (extra-corporeal) treatments by 29%; however, the differences were not significant.Conclusion: The CDSS implementation for electronic monitoring of the patient's condition and changes in his/hers parameters allowed for an earlier diagnosis of sepsis. We identified some prerequisites for more rational utilization of medical resources, mainly due to early, targeted treatment of patients with severe sepsis and septic shock; however, additional studies are necessary.

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Predictive Value of Soluble Programmed Death-1 for Severe Sepsis and Septic Shock During the First Week in an Intensive Care Unit

Shock ◽

10.1097/shk.0000000000001171 ◽

2019 ◽

Vol 51 (3) ◽

pp. 289-297 ◽

Cited By ~ 7

Author(s):

Yongzhen Zhao ◽

Yumei Jia ◽

Chunsheng Li ◽

Rui Shao ◽

Yingying Fang

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Predictive Value ◽

Programmed Death ◽

Programmed Death 1 ◽

Sepsis And Septic Shock

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Sepsis

10.2310/fm.1147 ◽

2020 ◽

Author(s):

Steven P LaRosa ◽

Steven M. Opal

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Organ Dysfunction ◽

Fluid Resuscitation ◽

Multiorgan Failure ◽

Sepsis Management ◽

The Past ◽

Sepsis And Septic Shock

Sepsis, along with the multiorgan failure that often accompanies this condition, is a leading cause of mortality in the intensive care unit. Although modest improvements in the prognosis have been made over the past two decades and promising new therapies continue to be investigated, innovations in the management of septic shock are still required. This chapter discusses the definitions, epidemiology, and pathogenesis (including microbial factors, host-derived mediators, and organ dysfunction) relating to sepsis. Management of severe sepsis and septic shock is also described. This review contains 5 figures, 11 tables, and 99 references. Keywords:Organ dysfunction, sepsis, septic shock, infection, bacteremia, fluid resuscitation, vasopressor

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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0020 ◽

2018 ◽

pp. 104-108

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Oxygen Demand ◽

Goal Directed Therapy ◽

Early Goal Directed Therapy ◽

Study Results ◽

Sepsis And Septic Shock

This case focuses on detecting sepsis through early goal-directed therapies by asking the question: Does aggressive correction of hemodynamic disturbances in the early stages of sepsis improve outcomes? Early goal-directed therapies are aimed at restoring a balance between oxygen delivery and oxygen demand. Patients included in the study were adults presenting to the emergency room with severe sepsis or septic shock. Study results indicated that most patients with severe sepsis or septic shock should be managed with aggressive hemodynamic monitoring and support immediately on presentation in the emergency department (or, if this is not possible, in the intensive care unit) for 6 hours or until there is resolution of hemodynamic disturbances.

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