Barriers and facilitators to effective electronic health record-based sepsis screening in the pediatric intensive care unit

Introduction The Pediatric Surviving Sepsis Campaign supports the implementation of automated tools for early sepsis recognition. In 2019 the C.S. Mott Children’s Hospital Pediatric Intensive Care Unit deployed an electronic medical record (EMR)-based screening for early recognition and treatment of sepsis. Materials and Methods We analyzed all automated primary sepsis alerts, secondary screens, and bedside huddles from November 2019 to January 2020 (Cohort 1) and from November 2020 to January 2021 (Cohort 2) to identify barriers and facilitators for the use of this tool. We distributed surveys to frontline providers to gather feedback on end-user experience. Results In Cohort 1, 895 primary alerts were triggered, yielding 503 completed secondary screens and 40 bedside huddles. In Cohort 2, 925 primary alerts were triggered, yielding 532 completed secondary screens and 12 bedside huddles. Surveys assessing end-user experience identified the following facilitators: (1) 73% of nurses endorsed the bedside huddle as value added; (2) 74% of medical providers agreed the bedside huddle increased the likelihood of interventions. The greatest barriers to successful implementation included the (1) overall large number of primary alerts from the automated tool and (2) rate of false alerts, many due to routine respiratory therapy interventions. Discussion Our data suggests that the successful implementation of EMR-based sepsis screening tools requires countermeasures focusing on 3 key drivers for change: education, technology, and patient safety. Conclusion While both medical providers and bedside nurses found merit in our EMR-based sepsis early recognition system, continued refinement is necessary to avoid sepsis alert fatigue. Lay Summary Sepsis recognition is important and has been endorsed by the Pediatric Surviving Sepsis Campaign. In the Pediatric Intensive Care Unit (PICU), we found the bedside huddle helpful, but the primary alert tool needs further improvement. Our data shows that successfully implementing sepsis screening tools using Electronic Medical Records (EMRs) requires a focus on education, technology, systems, and workflow. Many institutions are developing and refining sepsis screening tools, so sharing methodology can help promote recognition and early identification of sepsis. Our experience has identified barriers and facilitators that can help other institutions improve their sepsis screening process.