I have been in the informatics space for some time and none of these ML generated sepsis alerts are helpful in the ED.
We can readily tell who has sepsis when confronted with patient appearance, vital signs, and workup.
The issue is trying to find a signal in all of this data where they have an occult condition that we are not yet observing. These folks get sick real bad and real quick and we often do miss this!
Trying to find that signal with our current medical technology is difficult but there are some immune markers that could potentially alert us. These tests are now coming online and should be prevalent within the next few years. Hopefully, more research will show whether they are helpful or not.
Sometimes, even the best tests or calculators or ML generated alerts do not measure up to physician gestalt.
There’s a thread about how emergency physicians are paid. It varies from group to group:
Physicians can be salaried and receive benefits from their group or hospital
Physicians can be 100% productivity based meaning that they will only get paid by the amount of patients they treat but they receive no other benefits from the group or hospital
In between these two groups, there is a wide variety of compensation Packages that are complicated to discuss in this comment.
Nonetheless, the overwriting factor for all emergency physicians is that we triage patients, not only after triage, but internally as well, including those patients at reside within the treatment rooms and those outside in the waiting room.
The question is, can we see less patients and spend more time with them and the answer is yes but to the detriment of the entire department and possibly not seeing a patient who is sick and who hasn’t been seen yet. Do you have to be able to tell who you can spend five minutes with and who needs 30 minutes.
Through put his king, but quality is queen, so there’s always a trade-off between seeing patients fast enough and to see enough patients through your shift, but to also how they were with all to determine which patients will require more time and more due diligence.
Every shift is a pull and push between these two dichotomies and it’s never easy and there are multiple decisions that have to be made.
The ED is specifically attuned to these presentations but the sepsis alerts and algorithms in place are horrendous and will fire off even for this with viral illnesses and syndromes.
Sepsis alerts are meant to find bacteremia in patients who present with a set of vital signs and laboratory findings indicative of it and even those definitions are not readily agreed upon.
The ED is highly accurate with its diagnosis and treatments despite everything that has been said.
Trying to find a zebra in the hoof beats of horses when the number of patients quickly outstrips your department’s capabilities is a fools errand because if the workup require will overwhelm throughout to the point that the delay in care will put other patients at risk.
There is a fine line between doing enough and doing too much that will grind your department to a halt and then have your waiting room backing up.
Unfortunately for this patient, his occult condition didn’t manifest itself within his two ED visits and we don’t have prognostic capabilities to tell who will and won’t decompensate. We all make value judgements and treat the patients in front of us
We can readily tell who has sepsis when confronted with patient appearance, vital signs, and workup.
The issue is trying to find a signal in all of this data where they have an occult condition that we are not yet observing. These folks get sick real bad and real quick and we often do miss this!
Trying to find that signal with our current medical technology is difficult but there are some immune markers that could potentially alert us. These tests are now coming online and should be prevalent within the next few years. Hopefully, more research will show whether they are helpful or not.
Sometimes, even the best tests or calculators or ML generated alerts do not measure up to physician gestalt.