Saudi Arabia hospital uses Cerner algorithm to cut pediatric deaths from sepsis
According to the World Health Organization’s first global report, 49 million cases of sepsis occur every year with nearly half of those cases impacting children. Early recognition is critical to reducing this life-threatening response to infection. When sepsis is not managed properly, a patient’s condition can deteriorate into septic shock, multiple organ failure, and mortality.
In February 2016, King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh, Saudi Arabia implemented an electronic alert system to help detect sepsis and systemic inflammatory response syndrome (SIRS) earlier in pediatric patients.
Built off the Cerner St. John's Sepsis Algorithm, the system uses data analytics to evaluate patients’ vital signs. In situations where a patient is determined to be at risk for sepsis, the system sends a message to the care team and recommends steps to prevent the patient’s condition from deteriorating.
In 2020, leaders at KFSH&RC conducted a study to see how the electronic alert system was helping clinicians curb this global complication in their pediatric intensive care unit (PICU). By implementing this technology, leaders at the organization reported that the mortality rate for patients who were admitted to the PICU and later developed sepsis or severe sepsis had reduced significantly, from 29% to 17%.1
Dr. Abdullah Alturki, chief medical informatics officer at KFSH&RC, attributes this success to earlier detection. As a result, these alerts encourage clinicians to promptly manage the patient’s condition, therefore reducing the time to start critical clinical interventions.
“The outcome of the study was astonishing,” says Alturki. “Once these indicators’ numbers change, the system alerts the nurse to follow up on the case and see if it is an inflammation or an infection. Consequently, the nurse informs the attending physician about these developments, so they can provide relevant guidance on the examinations to be carried out or immediate antibiotic or fluid administration changes.”
As a result, KSFH&RC reported that the average time for patients to receive antibiotics was shorter by 23%,2 and that saline fluid bolus therapy was administered in an average of 30 minutes.3 Further demonstrating the impact of these timely interventions, the organization stated that on average patients were able to leave the PICU in under seven days.4
Leaders at the organization also hope to use the electronic alert system for patients suffering from kidney failure.
“We are developing a similar system tailored to kidney patients,” says Alturki. “In many instances, cases of kidney failure are discovered without warning, especially in patients who take a lot of pain relievers and antibiotics.”
Leaders at KFSH&RC also believe the technology could help clinicians monitor patients during busy periods by alerting clinicians to abnormal vital signs or if a patient’s condition worsens. While the alert system aids healthcare providers with timely clinical insights, Alturki doesn’t see the system as a substitute for experienced, caring healthcare providers.
“Nothing in the world can replace human care and closely observing the patient directly. These systems are meant to assist the doctor and do not replace their presence and human touch. They are great for alerting and drawing the attention of the nurse, but they do not replace the importance of clinical decision-making.”
Looking forward, KFSH&RC plans to fully integrate smart infusion pumps across its three hospitals to help improve clinician workflow, reduce medication errors, and provide accurate dosing for patients. The organization is also rolling out a comprehensive transplant documentation and workflow solution developed in collaboration with Oracle Cerner and the PowerChart Oncology solution to further drive personalized care for patients.
1Comparing the mortality rate of 29.93% from before implementation (Jan. 1, 2014 to Feb. 22, 2016) to 17.39% after implementation (Feb. 23, 2016 to Dec. 31, 2018). Metrics were reported by the client in a study published by Scientific Reports on nature.com.
2Comparing the average time of 170 minutes from before implementation (Jan. 1, 2014 to Feb. 22, 2016) to initiate the first dose of antibiotics to the average time of 131 minutes after implementation (Feb. 23, 2016 to Dec. 31, 2018). Metrics were reported by the client in a study published by Scientific Reports on nature.com.
3Time to administer the first dose of saline fluid bolus therapy from after implementation (Feb. 23, 2016, to Dec. 31, 2018). Average time to administer before implementation was 107 minutes (Feb. 23, 2016, to Dec. 31, 2018). Metrics were reported by the client in a study published by Scientific Reports on nature.com.
4The average length of stay in the PICU from after implementation (Feb. 23, 2016, to Dec. 31, 2018). Average length of stay in the PICU before implementation was 7.9 days (Feb. 23, 2016, to Dec. 31, 2018). Metrics were reported by the client in a study published by Scientific Reports on nature.com.