Surviving Sepsis Screening: The Unintended Consequences of Continuous Surveillance

Seven hours into her overnight shift, Dr Carter opens the computer to complete her sixth admission of the evening. “BEEP! BEEP! BEEP!” her pager interrupts with “Sepsis Alert,” the fourth in the past 48 hours for a 12-year-old boy with metabolic disease, technology dependence, and paroxysmal sympathetic hyperactivity who was admitted 1 week ago for dehydration and increased storming. She leaves her computer to attend the mandatory bedside huddle. The result is the same as the 3 previous ones: storming caused his fever and tachycardia, not sepsis; no change to management. As Dr Carter writes a progress note documenting the huddle, her pager erupts again, requesting orders for her other patient.

Pediatric severe sepsis in the United States costs $7.3 billion annually, one-fifth of pediatric hospitalization costs.¹ Over the past 2 decades, professional organizations have built awareness, developed guidelines, and driven efforts to recognize sepsis and intervene early in its course.^2,3 Early initiatives began in emergency departments (EDs), although state legal mandates and national quality improvement collaboratives have led to implementation hospital-wide, including in general inpatient units.^4,5

Most guidelines frame their recommendations around sepsis response systems that incorporate clinical decision support tools (hereinafter referred to as sepsis scores) to identify suspected sepsis and trigger time-sensitive bundles of laboratory evaluation, intravenous fluid resuscitation, …