A SERVICE FROM THE REAL TIME ANALYTICS (RTA) TEAM
Sepsis is defined as life-threatening organ dysfunction due to infection. Prior to COVID, there were more than 270,000 sepsis deaths annually (ref: CDC). COVID has added substantially to that burden: there have been more than 900 COVID deaths at Emory alone. Timely recognition of progressive organ dysfunction is essential to clinical decision-making that saves lives. Unfortunately, given the overwhelming number of patients and flows of data, the earliest signs of deterioration are easily overlooked.
A real-time dashboard to calculate a patient’s risk of developing sepsis in the near future using the sepsis-3 definition of:
- A 2-point degradation in Sequential Organ Failure Assessment (SOFA) score
- Recent orders of blood cultures, and
- Recent orders of new antibiotics
The dashboard displays details of patients with most recent SOFA >= 2 as compared to the minimum in the last 24 hours. The SOFA score is arrived at using a 24h table of all relevant clinical variables, and calculates each of the 6 organ system component sofa scores. These are represented as views in the database:
- Cardiovascular
- Liver
- Renal
- Central nervous system
- Respiratory
- Coagulation
These 6 database views are then combined with person Ids into a single view. The data from the consolidated view is then cached into a table every 6 hours along with a timestamp. The cached table is referenced to calculate the most recent total SOFA, the minimum total SOFA in the last 24h, and the difference between these. Those patients with a difference of >=2 are displayed in the dashboard. In addition, the dashboard pulls in blood cultures and antibiotics orders which are obtained from the Cerner database using order times. The most recent order time is assigned as tsuspicion. This information is then merged with inpatient information and their current locations.
The current implementation is a powerful tool to alert clinicians to unfavorable SOFA scores for inpatients. The RTA Team is proposing to add capability to flag such patient records through the dashboard by the clinician. Once flagged, the patient record will be highlighted until his/her SOFA score falls below 2. The clinicians will have the option of adding comments to the patient record each time they view the dashboard. This will ensure that the patient status is kept up-to-date.
STAKEHOLDERS
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| Dr. Craig Coopersmith, MD Professor, Dept. of Surgery Dr. Coopersmith is the clinical champion for the Real-time Sepsis Detection System. He is the Director of the Emory Critical Care Center and oversees all ICUs across the Emory Healthcare system. |
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| David Murphy MD, PhD Associate Professor, Department of Medicine Dr. Murphy is an Assistant Professor of Medicine at Emory University in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine. He is a physician, researcher, and expert in healthcare quality and patient safety. |
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| Raymund B Dantes, MD Associate Professor, School of Medicine |
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| Dr. David Wright, MD, FACEP Chair of the Department of Emergency Medicine Dr. Wright has served as interim department chair since August 2018. He started his career at Emory University School of Medicine in 1997 after completing his residency at the University of Cincinnati. He was recruited to be an Emergency Medicine clinician/researcher by the inaugural Department Chair, Dr. Arthur Kellerman |