Data from: An investigation of sepsis surveillance and emergency treatment on patient mortality outcomes: an observational cohort study

Objective. To determine the prevalence of initiating the sepsis 3-hour bundle of care and estimate effects of bundle completion on risk-adjusted mortality among ED patients screened-in by electronic surveillance. Materials and Methods. This was a multiple center observational cohort study conducted in 2016. The study population was comprised of patients screened-in by St. John Sepsis Surveillance Agent within four hours of ED arrival, had a sepsis bundle initiated, and admitted to hospital. We built multivariable logistic regression models to estimate impact of a 3-hour bundle completed within three hours of arrival on mortality outcomes. Results. Approximately 3% ED patients were screened-in by electronic surveillance within four hours of arrival and admitted to hospital. Nearly 7 in 10 (69%) patients had a bundle initiated, with most bundles completed within three hours of arrival. The fully-adjusted risk model achieved good discrimination on mortality outcomes (AUROC = .82, 95% CI = .79 to .85) and estimated 34% reduced mortality risk among patients with a bundle completed within three hours of arrival compared to non-completers. Discussion. The sepsis bundle is an effective intervention for many vulnerable patients, and likely to be completed within three hours after arrival when electronic surveillance with reliable alert notifications are integrated into clinical workflow. Beginning at triage, the platform and sepsis program enables identification and management of patients with greater precision, and increases the odds of good outcomes. Conclusion. Sepsis surveillance and clinical decision support accelerate accurate recognition and stratification of patients, and facilitate timely delivery of healthcare.**研究目的**：明确经电子筛查（electronic surveillance）纳入的急诊室（Emergency Department，ED）患者中，启动脓毒症3小时集束化治疗方案（sepsis 3-hour bundle of care）的比例，并评估完成该集束化方案对经风险校正后的患者死亡率的影响。 **研究对象与方法**：本研究为2016年开展的多中心观察性队列研究。研究队列纳入在抵达急诊室4小时内经圣约翰脓毒症筛查AI智能体（St. John Sepsis Surveillance Agent）筛查纳入、启动脓毒症集束化治疗方案且收入院的患者。本研究构建多变量logistic回归模型，以评估抵达急诊室后3小时内完成3小时集束化方案对患者死亡率结局的影响。 **研究结果**：约3%的急诊患者在抵达后4小时内经电子筛查纳入并收入院。近7成（69%）患者启动了脓毒症集束化治疗方案，其中多数方案在抵达后3小时内完成。经完全校正的风险模型对死亡率结局具有良好的区分度（受试者工作特征曲线下面积AUROC=0.82，95%置信区间CI=0.79~0.85），且估算显示，与未完成集束化方案的患者相比，抵达后3小时内完成方案的患者死亡率风险降低34%。 **讨论**：脓毒症集束化治疗方案对诸多高危易感患者而言是一项有效的干预手段；若将搭载可靠警报通知的电子筛查系统整合至临床工作流程中，该方案可在患者抵达后3小时内完成。自分诊阶段起，该平台与脓毒症诊疗程序即可实现对患者的精准识别与管理，进而提升患者获得良好结局的概率。 **结论**：脓毒症筛查与临床决策支持系统可加速对患者的精准识别与病情分层，并助力医疗服务的及时递送。