Tackling sepsis: the United States’ deadliest condition treated in hospital intensive care units.
When gathering evidence in the classic American TV show Dragnet, Sergeant Joe Friday famously warned witnesses to give him “just the facts.” Of course, a fact is a thing that is known or proved to be true. But how do you solve a case when the facts themselves are in question? Stephen Claypool, M.D., Medical Director at Wolters Kluwer Clinical Software Solutions’ Innovation Lab, and his team faced the same challenge when developing POC Advisor, a decision support system that detects escalating conditions early, and delivers patient-specific alerts and evidence-based treatment advice directly to the point of care, to help tackle sepsis.
What is sepsis?
Sepsis is the body’s overwhelming response to infection. There are more than 1 million cases of sepsis each year, according to the Center for Disease Control and Prevention and around 258,000 deaths in U.S. hospitals every year. It is not only the deadliest condition treated in U.S. hospital intensive care units but also, at an annual cost of around USD $20 billion, it is the country’s most expensive condition to treat.
For the first challenge tackled by POC Advisor, the goal was to develop decision support technology that could harness real-time patient data and trusted clinical knowledge to improve sepsis care. However, being sepsis, Claypool and the POC Advisor team knew it would be a complex task. They would have to take a long, hard look at the facts they were dealing with.
When is a fact not a fact?
As Jim O’Brian, M.D., says in the Wolters Kluwer Breakthrough video below, “One of the difficulties … in treating sepsis is there is no single sign or symptom … people come in with a wide variety of complaints … There is no single diagnostic test that tells us if [a] person has sepsis or not.”
In addition, as a ‘For the Record’ magazine interview with Claypool noted, from the American College of Chest Physicians to the Society of Critical Care Medicine, there are multiple definitions of sepsis.
Compounding the complexity, there are many variations of clinical criteria of sepsis. Different types of patients are at different levels of risk from the same symptoms. And physicians often document sepsis differently. All of this means that the diagnosis of sepsis is highly subjective and, thus, often inconsistently applied.
Considering the complexity of interdependencies and variations of the ‘facts’ in play, one of the core challenges was to figure out how to compare ‘apples to apples’ across all sources of data, so that POC Advisor could ultimately deliver highly accurate advice, at the right time, directly to the point of care.
Comparing apples with apples
Early on in the development of POC Advisor, Wolters Kluwer experts worked hard to normalise and map data to common terminologies across all the different available sources of medical evidence. Amongst many other sets of data, the Innovation Lab tackled rationalising the surviving sepsis guidelines. After much work, they developed a language and rules engine that together, could compare data apples with apples.
You can see how those language and rules engines work together with a patient’s EHR (Electronic Health Record) and alert system in the POC Advisor video below.