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

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Title: Digital alerting and outcomes in patients with sepsis: Systematic review and meta-analysis
Authors: Joshi, M
Ashrafian, H
Arora, S
Khan, S
Cooke, G
Darzi, A
Item Type: Journal Article
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.
Issue Date: 20-Dec-2019
Date of Acceptance: 4-Oct-2019
URI: http://hdl.handle.net/10044/1/87960
DOI: 10.2196/15166
ISSN: 2291-5222
Publisher: JMIR Publications
Journal / Book Title: JMIR mHealth and uHealth
Volume: 21
Issue: 12
Replaces: 10044/1/74398
http://hdl.handle.net/10044/1/74398
Copyright Statement: ¬©Meera Joshi, Hutan Ashrafian, Sonal Arora, Sadia Khan, Graham Cooke, Ara Darzi. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.12.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
National Institute for Health Research
National Institute for Health Research
National Institute of Health Research
Funder's Grant Number: NF SI 061710038
RDPSC 79560
RDPSC 79560
RDB21
RP-2016-07-012
Keywords: Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Medical Informatics
diagnosis
electronic health records
sepsis
medical order entry systems
outcome assessment (health care)
SEPTIC SHOCK
UNITED-STATES
CLINICAL-CRITERIA
IMPACT
EPIDEMIOLOGY
DEFINITIONS
IMPLEMENTATION
GUIDELINES
MANAGEMENT
SURVIVAL
diagnosis
electronic health records, sepsis
medical order entry systems, outcome assessment (health care)
Adult
Critical Illness
Electronic Health Records
Humans
Sepsis
Treatment Outcome
Humans
Sepsis
Critical Illness
Treatment Outcome
Adult
Electronic Health Records
08 Information and Computing Sciences
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Medical Informatics
Publication Status: Published
Article Number: ARTN e15166
Appears in Collections:Department of Surgery and Cancer
Department of Infectious Diseases
Institute of Global Health Innovation



This item is licensed under a Creative Commons License Creative Commons