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A Systematic Review and Meta-Analysis Can Digital Alerting Improve Sepsis Outcomes and Hospital Length of Stay?

44 Pages Posted: 17 May 2019

See all articles by Meera Joshi

Meera Joshi

Imperial College London - Department of Surgery and Cancer

Hutan Ashrafian

Imperial College London - Department of Surgery and Cancer

Sonal Arora

Imperial College London - Department of Surgery and Cancer

Sadia N. Khan

Imperial College London - West Middlesex University Hospital

Graham S. Cooke

Imperial College London

Ara Darzi

Imperial College London - Department of Surgery and Cancer

More...

Abstract

Background: The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies are beginning to transform healthcare and have the potential to improve the identification of sepsis. This paper systematically reviews the evidence on the impact of digital altering systems on sepsis related outcomes.

Methods: Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12th February 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay, mortality, intensive care length of stay as well as time to antibiotics. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded.

Findings: This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 11 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. A qualitative assessment of all studies was performed. There was evidence of a significant benefit of digital altering on hospital length of stay, reduced by 1.31 days (p=0.014), and ICU length of stay, reduced by 0.766 days (p=0.007). Although not statisticially significant there was a mortality reduction by 11.4% (p=0.769) and time to antibiotics was reduced by 126 minutes (p=0.134).

Interpretation: This review highlights that digital alerts can significantly reduce hospital and ICU stay. Further studies are necessary to identify the choice of alerting system according to patient status and pathological cohort.

Funding Statement: This paper is independent research funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC) and National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre (PSTRC). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.

Declaration of Interests: No authors had a competing declaration of interest.

Ethics Approval Statement: Due to the nature of the study ethical approval was not required.

Keywords: Diagnosis, Digital, Sepsis, Alert, Outcomes

Suggested Citation

Joshi, Meera and Ashrafian, Hutan and Arora, Sonal and Khan, Sadia N. and Cooke, Graham S. and Darzi, Ara, A Systematic Review and Meta-Analysis Can Digital Alerting Improve Sepsis Outcomes and Hospital Length of Stay? (May 10, 2019). Available at SSRN: https://ssrn.com/abstract=3386305

Meera Joshi (Contact Author)

Imperial College London - Department of Surgery and Cancer ( email )

Praed Street
London, NW1 1SQ
United Kingdom

Hutan Ashrafian

Imperial College London - Department of Surgery and Cancer

Praed Street
London, NW1 1SQ
United Kingdom

Sonal Arora

Imperial College London - Department of Surgery and Cancer

Praed Street
London, NW1 1SQ
United Kingdom

Sadia N. Khan

Imperial College London - West Middlesex University Hospital

Middlesex
United Kingdom

Graham S. Cooke

Imperial College London

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Ara Darzi

Imperial College London - Department of Surgery and Cancer

Praed Street
London, NW1 1SQ
United Kingdom

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