Impact of Protocol Watch on Compliance With the Surviving Sepsis Campaign

Abstract

Purpose Clinical decision support systems are intended to improve patients’ care and outcomes, particularly when such systems are present at the point of care. Protocol Watch was developed as a bedside clinical decision support system to improve clinicians’ adherence to the Surviving Sepsis Campaign guidelines. This pre/post-intervention pilot study was done to evaluate the effect of Protocol Watch on compliance with 5 guidelines from the Surviving Sepsis Campaign. Methods Preintervention data on rates and time to complete the resuscitation and management bundles from the Surviving Sepsis Campaign and time to administer antibiotics were collected from intensive care units at 2 large teaching hospitals in the United States. Training on the Protocol Watch application was then provided to clinical staff in the units, and Protocol Watch was installed at all critical care beds in both hospitals. Data were collected on rates and time to completion for 5 Surviving Sepsis Campaign guidelines after installation of Protocol Watch, and univariate analyses were done to evaluate the effect of Protocol Watch on compliance with the guidelines. Results Implementation of Protocol Watch was associated with significant improvements in compliance with the resuscitation bundle (P = .01) and decreased time to administer antibiotics (P = .006). No significant changes were achieved for compliance with the management bundle or time to complete the resuscitation or management bundles. Conclusions Clinical decision support systems such as Protocol Watch may improve adherence to the Surviving Sepsis Campaign guidelines, which potentially may contribute to reduced morbidity and mortality for critically ill patients with sepsis.

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

“…[24,25,30,32,34,36,37,40,41,43–45,49,52,53,59] Three studies showed increases in length of stay. [2,20,60] Three studies showed no change in length of stay. [18,50,61] Three further studies reported conflicting effects of CDS on length of stay across different intervention arms.…”

“…[19,28,31,35,51,60,63–66] Values for the percentage of compliance with guidelines are summarised in Table 5. CDS effects were measured as absolute percentage differences between CDS and intervention groups.…”

“…Guiliano and co-workers showed that CDS improved adherence to sepsis resuscitation and management bundles. [60] Tafelski and co-workers showed that ICU mortality was significantly increased in low adherence group (LAG) compared to high adherence group (HAG) (OR = 2.43, 95% CI 1.126 to 5.243). [39]…”

Systematic review of clinical decision support interventions with potential for inpatient cost reduction

“…29.5% of the studies occurred in an ICU setting [18,23,31,34-36,39,40,44,47],[51,57-59,63,65,68,73,79,82],[86,88,89], and 15.4% took place in an ED setting [13,20-22,27,29,38,45,75,81],[83,84]. …”

Advancing Critical Care Through Interdisciplinary Research

“…Adherence to the sepsis bundle is frequently included as a quality indicator for critical care practice. 6 However, recent research studies related to 3 of the elements of the sepsis bundle-recombinant human activated protein C (rhAPC), red blood cell transfusion, and tight glycemic control-have produced data that question the benefit of these components. Continued inclusion of rhAPC (drotrecogin alfa, marketed as Xigris by Eli Lily and Company) in the 2008 Surviving Sepsis guidelines was based on 3 studies that showed better outcomes for those patients with sepsis at high risk of death.…”