981: Evaluation of Burn Sepsis Automated Alerts in an Intensive Care Unit
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Learning Objectives In spring 2013 the burn unit initiated Sepsis Alert software. Continuous electronic medical record EMR screening used novel predictors of burn sepsis Burn6 Criteria heart rate HR 130 bpm, mean arterial pressure MAP 60 mmHg, base deficit BD -6 mEqL, temperature T 36 C, use of vasoactive medications VM, or glucose 150 mgdl. We hypothesize sepsis alerts will be both accurate and meaningful to the provider to avoid alert fatigue prior to expanding the number of clinical staff receiving the alerts. Methods Prospective observational study of alert performance was conducted. An automated email was sent to identified personnel. Simple rules included 2 of the parameters are out of range patient 48 hours post admission 12 hours post-operative and admitted to the intensive care unit. EMR was reviewed for clinical applicability for each alert. Descriptive and non-parametric statistics were used to describe variables when alert triggered vs not triggered. Results From 82013 72013 149 alerts were generated on 47 patients 3.7 3.6 range1-16 alertspatient with 24 16 total burn surface area. Frequencies of variables in alerts, with value mean SD for triggered vs not triggered respectively, were glucose 67, 181 32 vs 117 20 MAP 67, 56 4 vs 81 14 VM 48, 1.4 0.6 vs 0 0 HR 27, 139 14 vs 97 18 T 15, 35.6 0.4 vs 38 0.9 and BD 4, -8.2 3 vs 3.7 4 all p values within groups 0.0001. Each alert contained 2.1 0.31 range 2 4 variables. Patients were receiving antibiotics and antifungals concurrent with 5071 and 2170 alerts, respectively. Cultures were obtained after 765 alerts, and prior to 2765 alerts. Lactate was 2 mEq in 1555 instances. Conclusions BD and T appear to be poorly correlated with burn sepsis alerts. Most patients were receiving antimicrobial therapy when alert was triggered a small number of alerts preceded culture acquisition.
- Medicine and Medical Research
- Stress Physiology