New Sepsis Alert System Relies On Algorithms And A Nurse's Wisdom : Shots - Health News A bedside computer loaded with software that tracks vital signs in the ICU can pick up early warning patterns, specialists say. But it takes a human care provider to sort the signal from the noise.

Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early

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Disease and injury send people to the hospital, and once there, some of them develop a severe reaction to infection called sepsis. They may die from that rather than the original ailment. Patients do better when sepsis is identified early, so there's a nationwide push to catch it right away. NPR's Richard Harris visited Harborview Medical Center in Seattle to see how one early detection program works.

RICHARD HARRIS, BYLINE: One of the big challenges of sepsis is that it has no specific trigger and no clearly defined set of symptoms.

DAVID CARLBOM: Sepsis is a really frustrating disease. There's no blood test for sepsis. There's nothing you can look at under the microscope and say, this is sepsis. I see sepsis.

HARRIS: Dr. David Carlbom says instead, the condition generally comes with a spectrum of symptoms like high temperature, low blood pressure, fast breathing or a high white blood cell count. So he and his colleagues have been using the hospitals computerized medical records to scan automatically for these symptoms and to send up a flag if a pattern seems to be emerging. Rosemary Grant, a registered nurse and sepsis coordinator at the Harborview Medical Center, takes me to a nursing station at one acute-care ward to show me how it works.

ROSEMARY GRANT: And up here on the screens, you can see this is our sepsis screening. This is a system that was developed here in 2011 to try to catch patients with infection early.

HARRIS: The previous day, for example, a red box appeared by the name of a patient who had a bad motorcycle accident. The computer prompts the nurse responsible for that patient to assess whether the symptoms are a sign that sepsis could be developing.

GRANT: If the nurse says yes, then the provider is automatically paged out of the computer system.

HARRIS: The doctor is supposed to respond within half an hour, and the overall goal is to get a patient who might be developing sepsis antibiotics within three hours. But given the general nature of these symptoms, most of the time, the nurses will report it's a false alarm.

GRANT: If the nurse says no, the computer system just asks, why do you think the patient has these abnormal vital signs? And that just is kind of to say, oh, yeah, well, we know that he's in alcohol withdrawal, or he's in a lot of pain.

HARRIS: The stereotype I guess is that nurses just carry out the doctor's orders. But it seems as though that for sepsis, they're the critical eyes and ears here.

GRANT: Absolutely. You know, just having the nurses be really in tune with their patients I think is what makes the system work.

HARRIS: So has this made a difference?

GRANT: Yes. Since we've implemented the program in 2011, we've seen a decrease in mortality in our hospital.

HARRIS: We head over to the room of the injured motorcyclist to see how he's doing. Matthew Clark says his world changed abruptly after an unfortunate encounter with a car.

MATTHEW CLARK: I was just on the way to make some chicken chili for my girlfriend, and just a - you know, a young, distracted driver wasn't looking and kind of plowed into me. So...

HARRIS: Two big bones in his left leg were broken and required a series of operations to set right. But even a hardy 34-year-old isn't immune from infections in the hospital. His wasn't the subtle kind that required sleuthing from the hospital's computer system.

CLARK: A friend had sat down, and I waved to her. And I said - was about to say hello, and I noticed my hands were shaking. My blood started to leave my hands and feet. And I just looked at her, and I was like, I need some help.

HARRIS: The hospital's internal 911 team responded and, among other things, provided antibiotics to prevent his apparent infection from raging out of control.

CLARK: My temperature dropped incredibly. I'd never been so cold or shook so hard in my life.

HARRIS: But 24 hours later, he says he's back to his old self. Carlbom, who directs the Harborview sepsis program, says this patient's alert actually popped up on the screen long after the medical team had stepped in.

CARLBOM: I think his case is a great example of action happening before the computer catches up, right? The vital signs are measured and dealt with at the bedside before they're entered into the computer.

HARRIS: In fact, that need to enter vital signs manually into the electronic medical record is a shortcoming. The computer may be ever-vigilant, but it only gets new data to crunch a few times a day. Medical researchers are actively working to close that gap, says Dr. Matthew Churpek at the University of Chicago.

MATTHEW CHURPEK: We're partnering now with a company that has a device that goes under a patient's mattress and can actually continuously calculate their heart rate and respiratory rate in real time. And so I think the future of some of this early detection will be using these different devices in order to try to get these patients even earlier than we already are.

HARRIS: Churpek is also working to reduce the number of false alarms that are a problem both in Seattle and in similar systems around the country.

CHURPEK: And so that's one of the reasons why our group and other groups around the country have been trying to develop more specific and more accurate algorithms to identify these patients to try to decrease the false alarm rate.

HARRIS: Of course going hand in hand with detecting sepsis is finding better ways to treat the illness once it's found. As we reported yesterday, Dr. Carlbom in Seattle is trying out an experimental treatment for sepsis.

CARLBOM: But I think early discovery probably will impact mortality more.

HARRIS: Hospitals would welcome any movement since sepsis is the single most expensive condition they treat with a collective bill in the U.S. exceeding $20 billion a year. Richard Harris, NPR News.


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