Development, testing, and refining the failure to rescue sepsis sniffer

描述(由申请人提供)：本项目的目的是开发、测试和改进自动警报系统，以便在未能以适当和及时的方式对脓毒症做出反应后通知医疗保健提供者。由于大多数被诊断为脓毒症的患者是老年人，这种疾病对有特殊卫生保健需求的人的影响不成比例，包括残疾人、慢性病患者和面临临终关怀的人。然而，任何患者都可能发生败血症，需要重症监护住院。因此，这个项目与医疗研究和质量机构的使命有关，即提高所有美国人的医疗保健的质量、安全、效率和有效性。背景：治疗重症监护病人的一个主要挑战是在脓毒症确诊后延迟开始适当的治疗。此外，即使启动了快速治疗，它也可能是不完整的、不充分的和/或受到提供者错误的阻碍。脓毒症在诊断后不能及时和适当地作出反应可导致并发症，包括器官功能障碍、顽固性低血压、多器官功能障碍综合征和死亡。解决方案：在诊断出脓毒症后，及时给予适当的治疗已被证明显著改善了患者的预后。考虑到这一点，我们的假设是，一个自动警报系统，用于检测败血症诊断后的抢救失败，可以减少在ICU环境下实现适当反应的时间，从而改善预后。这项提议的目标是开发和测试一种自动警报系统，用于检测脓毒症诊断后未能抢救的情况。为此，我们提出了以下三个具体目标：(1)提高现有严重脓毒症嗅探器的诊断性能；(2)在实验中测试不同的自动警报传递模式；以及(3)使用医院电子病历对改进的严重脓毒症警报系统进行试点实时测试。我们的方法将包括算法优化、模拟实验和重症监护环境中的前瞻性测试。这项提议的长期目标是利用这项技术来改善患者的预后并降低总体不良发生率。这一知识意义重大，因为它将为开发日益复杂的自动检测系统奠定基础，以增强提供者改善患者结局和降低患者死亡率的能力。

DESCRIPTION (provided by applicant): The purpose of this project is to develop, test, and refine an automated alert system to notify healthcare providers following failure to respond to sepsis in an appropriate and timely fashion. Because the majority of patients diagnosed with sepsis are elderly, this disease disproportionately impacts individuals with special health care needs, including the disabled, chronically ill, and those facing end-of-life. However, any patient can develop sepsis and require critical care hospitalization. Therefore, this project is relevant t the Agency for Healthcare Research and Quality's mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Background: A major challenge in treating critical care patients is delay in initiating appropriate therapy upon sepsis diagnosis. Further, even when prompt therapy is initiated, it may be incomplete, inadequate, and/or hampered by provider error. Failure to respond to sepsis after diagnosis in a timely and appropriate manner can lead to complications, including organ dysfunction, refractory hypotension, multiple organ dysfunction syndrome, and death. Solution: Timely administration of appropriate therapy after diagnosis of sepsis has been demonstrated to significantly improve patient outcomes. With this in mind, our hypothesis is that an automated alert system for detecting failure to rescue after sepsis diagnosis can reduce time to achieve appropriate response in the ICU setting and thereby improve outcomes. The goal of this proposal is to develop and test an automated alert system for the detection of failure to rescue after sepsis diagnosis. To do this, we propose the following three specific aims: (1) improve the diagnostic performance of an existing severe sepsis "sniffer" (2) test different modes of automated alert delivery in experiment, and (3) pilot real-time testing of an improved severe sepsis alert system using the hospital electronic medical record. Our methods will include algorithm optimization, simulated experiment, and prospective testing in the critical care setting. The long-term goal of this proposal is to exploit this technology to improve patient outcomes and reduce overall adverse occurrence rates. This knowledge is significant as it will lay the foundation for the development of increasingly sophisticated automated detection systems to enhance the ability of providers to improve patient outcomes and reduce patient mortality.