Effect of Modified Early Warning Score on Identification and Treatment of Sepsis in Patients Admitted to Huntsman Cancer Hospital's BMT/HEME Unit

Topic Significance & Study Purpose/Background/Rationale: Sepsis is a leading cause of death of hospitalized patients. Patients with cancer are at increased risk of morbidity and mortality from sepsis; infection is the leading cause of death in patients with hematologic malignancies or undergoing transplantation. Studies have shown delays in antibiotic therapy are associated with increased risk of death. In this study, we describe a project to improve early recognition and treatment for patients with sepsis who are admitted to Huntsman Cancer Hospital in the Blood and Marrow Transplant/Hematology Unit. Methods, Intervention, & Analysis: To identify sepsis reliably and avoid alert fatigue, we used a modified Early Warning Score (mEWS).Tabled 1Modified Early Warning Score (mEWS)Measure3210123Temperature≤35.035.1-35.535.6-38.038.1-39.039.1-40.9≥41.0Respiratory Rate≤89-1112-2021-2526-29≥30Pulse≤3031-3940-100101-110111-130≥131Systolic BP≤8081-9091-100101-180181-200201-220>221 Open table in a new tab •A score ≥4 was the trigger to alert providers for possible sepsis.•February-August 2016, we evaluated 55 autologous and allogeneic transplant patient records for time to antibiotic administration, antibiotic change, ICU transfer and mortality.•Results compared with a historical control group of similar patients with comparable mEWS scores prior to mEWS implementation. Findings & Interpretation:•A total of 169 mEWS alerts (score 4 and higher) were generated in 55 patients.•A total of 5/61 and 2/46 patients in the study and control groups were started on antibiotics (P = .04).•Change in antibiotics occurred in 47/61 (74.6%) of the study group compared with 16/46 (25.4%) in the control (P < .0001).•Time to antibiotic administration was significantly shorter in the study versus the control group (37 min versus 68.1 min, respectively, P < .0001).•The number of transfers to the ICU were similar (21 versus 15%, P = .04).•Similar proportion of deaths (5 and 7%, P = .7) in the study and the control groups. Discussion & Implications: mEWS implementation was associated with a significantly shorter time to antibiotic administration and higher number of antibiotic changes. Although other outcomes like mortality didn't seem to be affected in this BMT group, further evaluation of the system in a larger prospective cohort is warranted.