Digital alerting and outcomes in patients with sepsis: Systematic review and meta-analysis

Abstract

Background The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies have the potential to improve sepsis care. Objective This paper systematically reviews the evidence on the impact of electronic alerting systems on sepsis related outcomes. Study Selection Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12thFebruary 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay [LOS] and intensive care LOS, secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded. All other trial designs were included. A qualitative assessment and meta-analysis was performed. Results This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 12 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. Data Synthesis Both quantitative and qualitative assessments of the studies was performed. There was evidence of a significant benefit of electronic alerting on hospital length of stay, reduced by 1.31 days[p=0.014], and ICU length of stay, reduced by 0.766 days[p=0.007]. There was no significant difference association between electronic alerts and mortality [mean decrease 11.4%,p=0.769] or time to antibiotics [mean decrease 126 minutes, p=0.134]. Conclusion This review highlights that electronic alerts can significantly reduce hospital and ICU stay in patients with sepsis. Further studies including more randomized control trials are necessary to confirm these findings as well as identify the choice of alerting system according to patient status and pathological cohort.