Alerts and Alarms-Can Electronic Medical Records Help Children and Adolescents Survive Sepsis?

Early recognition and treatment of paediatric sepsis has been shown to improve survival. Automated sepsis alerts embedded in electronic medical records (EMRs) offer real-time identification of high-risk patients and may improve timeliness of sepsis care, with possible limitations including overdiagnosis, overtreatment and alert fatigue. It is currently unclear whether automated alerts improve clinical outcomes in paediatric sepsis. We conducted a systematic review and narrative synthesis of studies evaluating clinical outcomes (mortality, PICU admission rate, length of stay), process measures (time to fluids/antibiotics, bundle adherence), and balancing measures (hospitalisation rate, antibiotic use) after implementation of EMR-based automated sepsis alerts in patients under 18 years of age. Twelve studies met inclusion criteria. Automated alerts were associated with improvements in process measures, notably reduced time to antibiotics (4/6 studies) and fluids (2/5 studies). Mortality was reduced in one study of PICU patients (29.9% vs. 17.4%, p = 0.011), and a trend towards reduced PICU admissions was observed. No significant impact on hospital or PICU length of stay was noted. Alerts did not increase hospital admission rates or antibiotic usage. Automated sepsis alerts may improve time to fluids and antibiotics in paediatric sepsis. While inconsistently reported, alerts were not found to increase hospital admission rates or antibiotic use. The impact on clinical outcomes, particularly mortality, remains uncertain. High quality randomised studies are needed to define their role in improving paediatric sepsis outcomes.