Provider/Pharmacist Sepsis Early Warning System for Initiating ED Antibiotics

Closeup saline intravenous (IV) drip for patient in hospital.
Can an EHR-based sepsis early warning system involving pharmacists and providers improve antibiotic administration in the ED and sepsis-related outcomes?

An electronic health record (EHR)–based sepsis early warning system (EWS) combined with an EHR–based pharmacist notification is associated with shorter time to antibiotic administration, according to a single-center quality improvement initiative published in Critical Care Medicine.

Sepsis is a prevalent, costly, and life-threatening condition, and earlier identification and treatment is associated with better clinical outcomes. Continued development of EHR–based decision support has prompted the development and implementation of numerous, automated rule–based sepsis screening tools and prediction-based EWSs.

Notably, randomized clinical trials showing efficacy of these tools in the emergency department (ED) setting are lacking. To address this, researchers assessed the impact of a pharmacist and provider facing sepsis EWS on the timeliness of antibiotic administration and sepsis-related clinical outcomes in the ED.  

From August to December in 2019, adults presenting to the ED of MetroHealth Medical Center in Cleveland, OH, were randomized to standard sepsis care or standard care augmented by the display of a sepsis EWS–triggered flag in the EHR combined with EHR–based ED pharmacist notification. A total of 598 patients were included in the study (285 in the intervention group, 313 in the standard care group).

Time to antibiotic administration from ED arrival was shorter in the augmented care group than that in the standard care group (median, 2.3 vs 3.0 hours; P =.039). The hierarchical composite clinical outcome measure (combining days alive and out of hospital at 28 days) was greater in the augmented care group than in the standard care group (median, 24.1 vs 22.5 days; P =.011). The researchers also found that rates of fluid resuscitation and antibiotic utilization did not differ between the groups.

The authors concluded, “Future studies will be required to determine whether the approach can be generalized to other healthcare systems and settings, particularly in circumstances where pharmacists may not be available to facilitate an EWS response.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Tarabichi Y, Cheng A, Bar-Shain D, et al. Improving timeliness of antibiotic administration using a provider and pharmacist facing sepsis early warning system in the emergency department setting: a randomized controlled quality improvement initiative. Crit Care Med. Published online August 20, 201. doi:10.1097/CCM.0000000000005267.