Figure 1. Schematic Representation of the Listening Application.

Upon admission to the MICU, patients were electronically monitored by the L.A. for development of modified SIRS criteria. Upon detection, patients were randomized to either the control or intervention arm. For patients randomized to the intervention arm, the L.A. generated pages and EMR notifications to physicians alerting them to the presence of modified SIRS criteria and requesting an assessment of whether or not the patient was septic.

^a If a patient was determined to be septic, then monitoring was suppressed for 7 days. After 7 days, the patient was again eligible for monitoring and notifications. Patients were only enrolled and analyzed after their first notification.

^b In the case of a patient determined NOT to be septic, monitoring was suppressed for 2 days. However, if either WBC or temperature was normal at the time of the alert and then became abnormal during the 2 days of suppression, then the rules engine allowed an additional alert to be sent to the provider. After 2 days, monitoring and notifications resumed as if the patient was new to the system. Patients were only enrolled and analyzed after their first notification.