It’s not news: Sepsis is deadly. The Canadian Sepsis Foundation estimates that 1 in 18 deaths in Canada are related to sepsis – a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Put another way, “Sepsis affects 30,000 Canadians each year and over one-third of these will die if not treated appropriately,” according to the Canadian Patient Safety Institute. We also know that sepsis is expensive, with the total cost of treating sepsis in Canada about $325 million per year.
Now for the good news: The Clinical and Systems Transformation (CST) project will introduce sepsis alerts as part of the new Cerner clinical information system, which is already in use at Lions Gate Hospital and Squamish General Hospital. The new system, and the clinical practice and process changes it supports, will be rolled out across Vancouver Coastal Health, the Provincial Health Services Authority and Providence Health Care in the coming years.
“As clinicians, we’re supposed to understand a lot of conditions that we take care of, but we’re all so busy. For a nurse who is on a surgical floor taking care of seven patients, the new alerts will be like an extra pair of eyes to help watch over our patients,” says Christine Jerrett, an RN and Clinical Informatics Specialist for Critical Care, Sepsis and Rapid Response with the CST project. “It’s not to take away clinical judgment; it’s to help support it.”
CST’s vendor partner, Cerner, uses an evidence-based algorithm called the St. John Sepsis Agent. It’s designed to detect situations that require early intervention for patients at risk, helping prevent deterioration into sepsis or septic shock. It’s always working in the background. As nurses document their patient assessments and the lab enters information in the system, the system is constantly evaluating the patient to see if they meet certain criteria, and if so, an alert is sent out.
“For many clinicians, these alerts are absolutely a game-changer,” says Faiza Ali, Clinical Informatics Analyst – an RN who recently left the ICU to join the CST project. “If I’m taking care of someone and I get real-time information that prompts me to think about another patient, it directs the flow of care and it’s so much better for our patients.”
When it comes to sepsis, the Canadian Patient Safety Institute asserts that speed and appropriateness of therapy improves patient outcomes, and the research backs this up. In a 2009 report released by the Canadian Institute for Health Information, Dr. Marc Francis stated that for every hour delay of sepsis shock before you get antibiotics on board, survival has been shown to decrease by 7.5 per cent.
“Research continues to support that early identification of septic patients and then quick administration of basic interventions such as IV antibiotics and IV fluids are the key to improved survival,” says Dr. David Sweet, Critical Care and Emergency Medicine at VGH, and the provincial clinical lead for sepsis quality improvement. “The new sepsis alerts within Cerner will allow us to quickly identify septic patients so we can make sure they receive the best care.”