Impact of Integrating a Neonatal Early-Onset Sepsis Risk Calculator into the Electronic Health Record

Abstract

Introduction: Investigators from Kaiser Permanente developed a risk-assessment calculator as a tool for evaluation of early-onset sepsis (EOS) to narrow antibiotic use for the treatment of EOS. The integration of the EOS risk calculator into an electronic health record will minimize manual calculations and data entry and improve compliance and accuracy through automation. Methods: We performed a retrospective chart review for neonates ≥34 weeks and 0 days gestational age. We collected data pre-integration and post-integration of the EOS risk calculator. The primary outcome measure is the accuracy of user input into the calculator. Secondary outcomes include compliance with using the EOS risk calculator, impact on clinical recommendation when incorrectly calculated, assessment of antibiotic utilization rate (AUR), and comparison of EOS risk calculator recommendations with Centers for Disease Control and American Academy of Pediatrics recommendations. Results: Miscalculations occurred in 52% of instances pre-integration and 19% of instances post-integration; P < 0.001. Compliance was 93% pre-integration and 98% post-integration; P = 0.138. Clinical recommendations were changed for 21% (13/62) of miscalculations pre-integration and 4% (1/23) of miscalculations post-integration; P = 0.099. The AUR for combined NICU and nursery patients was 47 pre-integration and 47 post-integration; P > 0.999. Six cases of culture-positive sepsis were identified, and all recommendations generated by the EOS risk calculator were in alignment with current Centers for Disease Control/American Academy of Pediatrics treatment guidelines. Conclusions: Integration of the EOS risk calculator into the electronic health record significantly increased calculator accuracy, although it did not show statistically significant differences with regards to compliance, clinical recommendations, or AUR.