Sepsis detected early using new tech

Sepsis patients are being diagnosed and treated earlier with the help of new technology at Wirral University Teaching Hospital NHS Foundation Trust.

The trust is using an alerting system as part of its Cerner Millennium electronic patient record to help staff identify patients at risk of the condition.

Wirral went live in A&E in May and the system was rolled out trust-wide in July.

Speaking to Digital Health News, Mark Hughes, consultant in intensive care medicine and anaesthesia sepsis lead, said that it was still early days, but initial signs are encouraging for the effectiveness of the alert, which is part of a new pathway for sepsis that launched 18 months ago.

“We are pretty happy that what we have got now does what it says it should do,” said Hughes. 

“That means everyone who alerts needs to be screened and everyone who you suspect [has sepsis] and has an infection needs to be treated.”

The system is a version of Cerner’s existing sepsis module, which the trust has adapted and “anglicised” to fit its own needs.

It uses a set of early warning scores based on international criteria for systemic inflammatory response syndrome, a condition closely related to sepsis. These criteria include abnormal levels in six parameters, including heart rate, respiratory rate, temperature and white cell count.

Due to the integrated nature of the Millennium system at the Wirral, which provides the entire suite of electronic patient record services at Wirral University Teaching Hospital, several of these parameters can be monitored constantly by the system.

If three of the parameters register at an abnormal level a patient is deemed to be at risk at developing sepsis and the next time a clinician logs into the patient’s record they are prompted with an alert that asks if there is clinical suspicion of, or a proven new infection.

If a clinician answers no, they are encouraged to investigate non-infectious causes of SIRS, but if the answer is yes then a patient is diagnosed with sepsis.

For sepsis patients, there is a further set of parameters that are analysed and if one of these registers as abnormal, the patient is deemed to have severe sepsis and immediate attention is required.

“We now have a working alerting system that will hopefully pick up all potential sepsis patients,” said Hughes.

Mark Blakeman, director of informatics at Wirral, said the tool was the result of “at least five years’ worth of work to get a complete digital record” at the trust.

“The only reason we can do this is because we are collecting all this information digitally across the organisation as part of our EPR.”

Due to the recent rollout, the full impact of the system is still to be determined, although Hughes mentioned that the trust was already seeing an increase in the number of people coded with sepsis.

Other benefits the trust expects include a reduction in the length of stay, as people will be treated sooner.

Hughes added that the introduction of the system has not led to a significant increase in the prescription of antibiotics. Instead, patients are just receiving antibiotics at an earlier stage.

“We are doing what we should be doing in a more timely fashion, which is exactly what we wanted to happen. It’s early days but the signs are encouraging.”

The plan now is to increase and improve staff education on sepsis and the system. This includes the introduction of sepsis education into the trust’s mandatory training.

Read more about Wirral's work on its electronic patient record in Features.