Mount Sinai EMR program slashes sepsis deaths

Mount Sinai Hospital in New York City is expanding a successful sepsis-reduction program hospital wide in January after a test program using alerts generated by electronic medical records cut sepsis rates by 40 percent, the Canadian Medical Association Journal reported.

The EMR intervention program triggered a red alert based on subtle changes in vital signs, including higher temperatures and pulse or breathing rates, that rarely prompted intervention in the past, according to the report.

"There was a much greater appreciation of the seriousness that is suggested by these abnormalities in vital signs, and a significant reduction in any apprehension that may have existed before to call on an advanced-level provider," Charles Powell, Mount Sinai chief of pulmonary and critical care medicine, told CMAJ

Sepsis is the leading cause of death in hospitals. Before the EMR program, sepsis rates at Mount Sinai were higher than at peer hospitals, accounting for about half of all deaths at the hospital, according to the article.

On the eight floors involved in the test program, the EMR alert results in a team of specially trained nurse practitioners visiting and evaluating the patient, ordering tests and starting treatment if necessary, CMAJ reported.

"When we began the program, the mean sepsis mortality rate was about 33 percent ... now it's at 16 percent," close to the best-performing peer hospitals, Powell told the publication. "We're now able to identify patients with sepsis earlier and standardize our response, and using our EMR data, we're also able to measure that response in terms of timeliness and outcomes, including transfers to intensive care and mortality."

Other sepsis-intervention programs also have helped cut infection rates. A two-year collaborative program at nine hospitals under the University of San Francisco's Integrated Nurse Leadership Program improved sepsis mortality rates by 54.5 percent in a year, with nurses screening all new patients at admission and at the beginning of each shift, fast-tracking a workup for patients with at least two signs of possible sepsis.

In August, two physicians writing in Forbes argued that a simple blood test and adoption of a protocol could save nearly 70,000 Americans each year from dying of sepsis in hospitals.

For more information:
- here's the CMAJ article