Flow diagram illustrating alert performance in the ED population during the study period. ESA+ indicates patients that had positive both first and second stage alerts which resulted in a sepsis huddle. Of the ED census, there were 15,292 patients with a positive first stage alert, and of these 1112 had positive answers to one of the screening questions (high risk condition, abnormal capillary refill, or abnormal mental status) which resulted in a positive ESA and huddle. Of these, 265 were treated on the sepsis protocol. There were 43 additional patients with clinician identified sepsis (CIS) who were treated with the sepsis protocol despite a negative ESA.