OBJECTIVES: Sepsis presents a huge healthcare problem striking millions of people worldwide and killing 25% of patients affected by the disease. Adoption of clinical pathways (CP) helped reduce lethality, mortality and hospital LOS. However, the adherence to CP is still a challenge for many hospitals. The objective of this study is to create a digital monitoring system for tracking the CP execution and sending alerts regarding deviations from protocol in real time; and evaluate its impact on protocol adherence.

METHODS: The system was deployed at the Hospital Samaritano in Brazil through dashboards installed at four different locations in the emergency department (ED), allowing easy monitoring by any member of the ED team. The system was configured to emit visual alerts if deviations from CP were detected, e.g. exceeded times for antibiotic or fluids administration. Evaluation was done by comparing institutional sepsis indicators before (Jan-May) and after (Aug-Nov) the use of the system. Results were submitted for assessment to the ED manager to check if any external factors could have influenced the results.

RESULTS: The study evaluated system’s performance using data from 267 patients. The results showed a significant improvement in the sepsis indicators. Average time for antibiotic was reduced from 45 to 33 minutes (36.43%); average transference time (from ED to ICU) decreased from 4:42 to 4:13 hours (11.37% ); LOS for septic shock patients decreased from 6.83 to 5.37 days (27.31%), while LOS for patients without septic shock decreased from 3.43 to 2.81 days (21.85%). Although overall adherence rate was already high (91.41%), it was further increased to 94.4%.

CONCLUSIONS: Results show that a clinical pathways management system can improve protocol adherence and sepsis indicators. As future work, we suggest the evaluation of the system in hospitals with low adherence rates, as well as evaluate it for other diseases.