I can appreciate day-to-day and system-by-system scoring in the ICU setting, but I'm a little hesitant to pretend like SIRS findings aren't there in an acute, early onset of sepsis hat hasn't yet progressed to shock, esp. in the ED.  Mentating with a SBP of 110 (but a MAP of 55) in triage shouldn't make a pt fall off the radar.

TL;DR But thats way we've always done it!


 

We built MEWS into our EMR to do that same thing.  Instead of relying on staff to call RRT/MET when certain clinical triggers exist the EMR will automatically page.

 
If you check "yes" in enough boxes in the rapid sepsis screen in the ED intake (and only there, not anywhere inpatient), it will give you pop-up to open the sepsis bundle order set.  The auto-trigger one would piss me off quite honestly.  I can think of a thousand clinical scenarios that aren't even remotely sepsis but would trigger the Epic alarm, like a new or chronic quadriplegic, hypotensive at baseline, has a bump in their white count and the cavalry gets gang paged, meanwhile it's an inflammatory response to some surgery they just had.


It does not, can not, and should not replace clinical gestalt - and every proponent of it will say that's not the intent - but it is.  It's being implemented because people at the bedside are missing subtleties, and maybe even some glaringly obvious signs.  Better education and clinical acumen for nurses would be a better start but, of course, we run into the issue of teaching to the lowest common denominator.