Objectives. Patient safety practices (PSPs) focused on sepsis prediction and recognition, encompass interventions designed to identify patients with sepsis early and improve timely adherence to guidelines. Our objectives were to review the evidence published after the previous Making Healthcare Safer (MHS) report to determine the effectiveness of sepsis prediction and recognition PSPs on patient safety related outcomes.
Methods. We searched PubMed and the Cochrane library for systematic reviews and primary studies published from January 2018 through August 2023, supplemented by gray literature searches. We included reviews and primary studies of sepsis prediction and recognition PSPs reporting measures of clinical process (time to diagnosis or treatment, adherence to guidelines, Severe Sepsis and Septic Shock Early Management Bundle), patient outcomes (hospital or intensive care unit (ICU) length of stay, mortality), implementation (use, barriers, and facilitators), or costs.
Findings. We focused on 7 systematic reviews and 8 primary studies that were eligible for full review, and briefly summarized 36 pre-post studies that lacked a separate comparison group. All the sepsis prediction and recognition PSPs were multi-component interventions. Across the systematic reviews and primary studies of neonates, the PSPs improved clinical process measures (low strength of evidence), but evidence was insufficient about length of stay or mortality outcomes. Across the systematic reviews and primary studies of adults, the PSPs did not demonstrate an effect on clinical process, length of stay, or mortality outcomes. In primary studies of adults, evidence was insufficient in the prehospital setting for mortality, length of stay, and clinical process measures. In the emergency department setting, strength of evidence was low for mortality and clinical process measures and insufficient for length of stay. In ward or hospitalwide settings, strength of evidence was low across all three outcome types. The secondary outcome of alerting system performance (e.g., positive predictive value) could not be meaningfully compared across studies due to diversity in populations and interventions.
Conclusions. This review finds that recent primary studies and systematic reviews do not support that specific PSPs for sepsis prediction and recognition are effective at reducing mortality or length of stay or improve clinical processes in adults in pre-hospital, emergency department, or hospitalwide settings as compared to usual care. Sepsis prediction and recognition PSPs may improve clinical process outcomes in neonates in ICUs.
Cherian J, Segal J, Sharma R, Zhang A, Bass E, Rosen M. Patient Safety Practices Focused on Sepsis Prediction and Recognition. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 75Q80120D00003). AHRQ Publication No. 23(24)-EHC019-13. Rockville, MD: Agency for Healthcare Research and Quality. April 2024. DOI: https://doi.org/10.23970/AHRQEPC_MHS4SEPSIS. Posted final reports are located on the Effective Health Care Program search page.
