Title : Implementing an electronic screening tool to improve antimicrobial prescribing decision-making for paediatric patients with suspected sepsis at an academic hospital in England: A before and after study
Abstract:
Background:
• Sepsis is one of the most common leading causes of death in paediatric patients worldwide.
• The WHO has defined sepsis as “a life-threatening organ dysfunction caused by a dysregulated host response to infection”
• Early recognition of the sepsis plays a critical role in reducing mortality rate.
• Electronic health record systems (EHR) are powerful platforms on which screening tools with clinical decision support systems (CDSS) can be developed and implemented to expedite the sepsis recognition process.
Aim: To examine the impact of using paediatric sepsis screening tool (PSST) on antimicrobial prescribing decision-making in paediatric patients with suspected sepsis in an academic hospital in England.
Method: Uncontrolled before and after study using data extracted from the EHR system. We included all paediatric patient (≤ 16 years old) who admitted to the emergency department (ED) with suspected sepsis from September 2021 to February 2023. Data analysis involved descriptive and comparative statistical analysis were performed by using SPSS version 29.0.
Results: Out of 27,475 ER admissions 820 (3%) patients were recognised as suspected sepsis. In total, 447 (55%) were male, 668 (81%) aged 5 years or less, 301 (37%) admitted in the Autumn, 507 (62%) has fever as chief complaint, 370 (45%) has prescribed antimicrobial medications, penicillins and cephalosporins were the most common used antibiotics (n=194, 52% and n=132, 36%, respectively). The PSST has significantly delayed the screening of sepsis (mean difference=232 minutes, P=<0.001), and prolonged stay at the ED
(mean difference=98 minutes, P=<0.001), decreased sepsis documentation rate (Percentage difference= 16%, P=<0.001).
Conclusion: The utilisation of the PSST has been associated with significant delays in screening patients with suspected sepsis, prolonged stay at the ED, and decreased sepsis documentation rate, highlighting the need for frequent follow-ups with the end users to ensure its potential effectiveness. One major challenge in evaluating screening tools and CDSS within EHRs is the lack of standardised guidelines on how and when to conduct evaluations, leading to inconsistency in evaluation methods and results, making it difficult to compare the effectiveness and impact of different CDSS designs. Therefore, further studies are needed to develop evaluation frameworks and guidelines for EHRs.
