Development of a Sepsis Management Clinical Decision Support Intervention

초록

Severe sepsis and septic shock are common causes of death, which is a disease state requiring timely and directed interventions. A lack of recognition of early shock and inadequate knowledge, experience and skills of providers lead to delays in appropriate treatment and transfer to the intensive care unit(ICU). To increase clinician's adherence to the clinical sepsis guideline of Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008, we developed the CDS interventions using the interoperable CDS architecture and standard-based knowledge expression approach. As for the evaluation of the accuracy and timeliness of advice given, we conducted a laboratory function study by recruiting potential users as a focus group. We used 14 scenarios designed to trigger full set of advices of 280 for the CDS. Four nurses of emergency room and ICU and two physicians with internal medicine specialty from National Police Hospital were participated. The system showed high accuracy and timeliness of advice given, at 97.9% and 97.5% respectively. The participants addressed the useful responses to be considered when the system integrated into task and workflow of hospitals. Through the study, we could improve logical consistency of the system and get the insight on the system integration into clinical workflow.