Sepsis screening… does addressing one problem lead to another?

In the wake of widely publicized events where children died from sepsis misidentified as another condition, numerous states have enacted laws requiring hospitals to implement evidence-based processes quickly recognize and intervene appropriate (https://www.cdc.gov/hai/pdfs/sepsis/VS-Sepsis-Policy-FINAL.pdf). These include Gabby's law in Illinois Rory's Regulations New York. Although these initiatives sparked lively conversation about proper role for legislation clinical care, particularly when prompted by single cases, mandates demonstrated success (JAMA 2018;320:358-67). The problem appropriately recognizing is real, emergency departments not accustomed caring children. However, one argument frequently advanced that such may lead unnecessary inappropriate interventions who do need them. study Baker et al this volume Journal sought answer question. This center implemented a screening algorithm electronic health record (EHR) (Figure). As common implementing alerts, screen was first silent providers ensure it functioned EHR. Subsequently alert activated use real time. provided unique opportunity compare 2 time epochs, identified patients an identical fashion, but during 1 period functioning silently background then later visible team. investigators focused on false positive screens. Sepsis screens are well known high rate, number conditions produce constellation findings which should be differential diagnosis. Their intent prompt careful patient evaluation, prescribed intervention, enhance acumen, substitute judgment. comparing periods they found there no difference receipt antibiotics or fluid boluses initially screened did sepsis. Clinicians react providing interventions. reassuring news, refutes contention skeptics unwarranted costly care. does completely eliminate concern. reflects practice quaternary care pediatric hospital with broad experience both look-alike presentations. A parallel non-pediatric settings will help refine could further Article page 193 ▸ Effect Screening Algorithm Care Children False-Positive AlertsThe PediatricsVol. 231PreviewTo determine if implementation automated low predictive value led resource utilization department (ED) evidenced increased proportion false-positive receiving intravenous (IV) antibiotics. Full-Text PDF