1041. The Influence of Patient and Organizational Factors on a Hospital-Wide Sepsis Screening Tool
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Posters
  • IDWeek Sepsis Screening Tool.pdf (1.1 MB)
  • Background: Following the 2012 Surviving Sepsis guidelines, screening for sepsis and subsequent aggressive treatment is increasingly adopted. While a multitude of screening tools exist, little is known on patient and organizational factors that may affect screening. With a sepsis screening tool (“STOP Sepsis”, SS) embedded in our electronic medical record (EMR) we aimed to assess the influence of these factors on sepsis screening, thus providing information on ways to improve our screening.

    Methods: We used retrospective data from a large urban, tertiary care hospital with a hospital-wide EMR-embedded sepsis screening program (SS). A positive screen leads to a rigorous clinical adjudication and appropriate intervention. We included all patients who screened positive from April 2014- December 2015 (n=2944). We then stratified severe sepsis and septic shock prevalence along with mortality (MORT) by year, screening location (emergency department, inpatient; ED, IP), patient age (<18, 18-64, ≥65), time of alert (7am-7pm or 7pm-7am), number of screening alerts (1 or >1), and the first alert in ≤24 or ≤48 hours of admission.

    Results: Overall, among inpatients who screened positive, severe sepsis and septic shock incidences were 29.4% (n=516, MORT 25.6%) and 5.6% (n=99, MORT 52.5%); this was 40.2% (n=710, MORT 19.0%) and 10.3% (n=182, MORT 42.3%) in the ED. While age stratification showed the highest mortality risks in those aged >65, stratification based on the screening alert firing in ≤24 or ≤48 hours of admission was the greatest inpatient screening modifier. Only a minority of alerts fired in ≤24 or ≤48 hours of admission with severe sepsis and septic shock incidences of 31.0% (MORT 20.2%) and 5.3% (MORT 27.3%) ≤24 hours, and 28.9% (MORT 27.4%) and 5.7% (MORT 59.7%) >24 hours after admission. Interestingly, having >1 screening alert (24.3% of cases) coincided with higher severe sepsis mortality: 24.2% and 29.2% for 1 alert versus >1 alert.

    Conclusion: From our preliminary unadjusted data it appears that sepsis screening and mortality risk differ based on not only expected patient factors but also organizational factors. In addition to the current discussion on simplifying and standardizing sepsis screening criteria additional analyses should further elucidate the need for subgroup-specific sepsis screening.

    Peter Shearer, MD1, Jashvant Poeran, MD, PhD2, Ken Mccardle, MS3, Madhu Mazumdar, PhD4, Gopi Patel, MD5, Vicki Lopachin, MD, MBA6, Allison Glasser, BSPT, MBA6 and Scott Lorin, MD MBA7, (1)Department of Emergency Medicine, Mount Sinai Hospital, New York, NY, (2)Institute for Healthcare Delivery Science, Department of Population Health Science and Policy / Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, (3)Office of the Chief Medical Officer, Mount Sinai Health System, New York, NY, (4)Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, (6)Office for Excellence in Patient Care, Mount Sinai Hospital, New York, NY, (7)Mount Sinai Brooklyn Hospital, Brooklyn, NY

    Disclosures:

    P. Shearer, None

    J. Poeran, None

    K. Mccardle, None

    M. Mazumdar, None

    G. Patel, None

    V. Lopachin, None

    A. Glasser, None

    S. Lorin, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.