Assessing the Early Sepsis Warning System in the Emergency Department.

Abstract

Background: Early detection and timely intervention are critical in managing sepsis. To address challenges in sepsis recognition in the emergency department, we implemented a two-stage Early Sepsis Warning System (ESWS) integrated with our electronic medical record (EMR) system.

Objective: This study aimed to evaluate the clinical impact of the ESWS on sepsis management and patient outcomes in the emergency department.

Methods: We conducted a retrospective observational study analyzing data from patients admitted with sepsis or septic shock between July 1, 2019, and June 30, 2022. The study period was divided into pre-ESWS and post-ESWS implementation phases. The primary outcome was in-hospital mortality; secondary outcomes included ICU admission rates, length of ICU and hospital stay, and frequency of lactate measurement.

Results: A total of 4,028 patients were included in the study. There was no significant difference in in-hospital mortality rates between the pre-ESWS and post-ESWS periods, with rates of 8.85% and 8.39%, respectively (p = 0.599). However, ICU admission rates significantly decreased from 11.87% to 9.31% (p = 0.008). The proportion of patients undergoing lactate testing increased substantially after the implementation of the ESWS, rising from 10.39% to 38.72% (p < 0.00001). Subgroup analysis showed improved outcomes among pneumonia patients, which included reductions in ICU admissions and shorter hospital stays.

Conclusions: The implementation of the ESWS was associated with reduced ICU admissions and improved adherence to sepsis care processes, particularly among patients with pneumonia. However, its impact on overall mortality was limited, highlighting the need to enhance system utilization and tailor interventions to diverse clinical contexts.