UHN is launching enhancements to an early warning and response system that uses data to alert clinicians about sepsis cases in patients before they can cause harm.
National Early Warning System 2 (NEWS2) is a digital tool that helps clinicians identify patients who are showing signs of deterioration, which may be from a potential infection, sooner.
Using vitals routinely collected at the bedside, NEWS2 creates an aggregated score from zero to 20 that indicates how severely a patient's health is declining. Scores greater than five, along with additional Systemic Inflammatory Response Syndrome (SIRS) criteria, suggest the patient may be developing sepsis.
Scores greater than seven indicate a patient is at risk of or experiencing septic shock — a medical emergency that requires treatment within an hour.
NEWS2 is integrated into Epic, UHN's electronic health records system, which triggers an alert that guides clinicians through what is known as the sepsis pathway — a standardized response to determine if sepsis is the suspected cause and what the appropriate action should be.
The goal is to enable providers to intervene before an infection becomes deadly.
"The earlier that patients receive expert treatment for sepsis, the more likely they are to survive," says Dr. Andrew Steel, a critical care physician and Medical Director of the Medical-Surgical Neuro Intensive Care Unit at UHN's Toronto Western Hospital.
The sepsis alert provides clinicians with a clear sense of how urgently a patient needs care and provides an opportunity to respond with evidence-based sepsis treatment guidelines.
"By intervening promptly, we can reduce morbidity, improve patients' chances of full recovery, increase survival rates and shorten hospital stays."
What is sepsis? Why is it hard to detect?
Sepsis, often called a "silent" medical emergency, occurs when the body's response to an infection spirals out of control, potentially leading to septic shock, organ failure and, in some cases, death.
Despite how serious sepsis is, there is no single test that confirms it. According to the World Health Organization, sepsis can be difficult to recognize until a patient's health has rapidly deteriorated, making early intervention a challenge worldwide.
Originally launched in 2024, NEWS2 was designed to help clinicians detect, interpret or appreciate early signs of a patient's clinical deterioration.
Through continued development, it has become more sophisticated at detecting sepsis and septic shock, including how the condition is monitored, diagnosed and managed, based on the latest scientific evidence.
UHN is building on that work this September with an update to make it more effective and efficient.
Earlier this year, the Ontario government required hospitals in the province to put in place processes for early sepsis identification and response by March 2027. UHN is at the forefront of those efforts and is now working alongside the province to inform implementation processes at other hospitals.
"At UHN, patient safety is grounded in evidence and data," says Dr. Lucas Chartier, Vice-President of Quality, Safety and Clinical Adoption. "By leveraging NEWS2 data from across the organization, we can help ensure patients at risk of developing sepsis are identified early and receive a consistent, evidence-based response.
"It takes a co-ordinated effort across TeamUHN, but that work ultimately leads to better care and outcomes for our patients."
Statistically, 80 per cent of sepsis cases at UHN are diagnosed in patients when they arrive at the hospital's emergency departments. The remaining 20 per cent of patients develop sepsis in hospital from complications of surgery or a medical condition.
Patients who are particularly at risk, and are now monitored more closely, include people who are older than 65 years, have weakened immune systems, have devices or lines inserted into the body, and those with diabetes.
Reacting to patient needs more quickly
For Julia Kim, a complex continuing care nurse practitioner at UHN's Toronto Rehab Bickle Centre, NEWS2 is a quick reference tool that helps her team determine what is "normal" for a patient, or what may signal a developing problem that warrants investigation.
Since many of her patients have lost the functionality of a major organ, it's common for vital signs to be abnormal. Many are also unable to communicate how they feel.
This can make infections especially difficult to detect and puts patients at an increased risk of sepsis.
"A high NEWS2 score is a stop-and-think moment," says Kim.
"Sometimes it's a patient's baseline. But, other times, it allows us to investigate something that otherwise might not have been picked up."
That was the case for one patient whose NEWS2 score typically ranged between five and six because of underlying medical conditions. When the score suddenly increased to 11, the patient was immediately escalated through the sepsis pathway.
The team quickly began treatment with intravenous fluids and antibiotics. The patient improved and avoided being transferred to the emergency department.
"That alert helps all of us ensure that we are treating the right people, doing tests on the right people, and treating them in a timely fashion so that they don't get sepsis," says Dr. Sabrina Lim Reinders, Toronto Rehab Chief of Family Medicine Hospitalist and medical director at Bickle Centre.
NEWS2 is also generating data that helps UHN understand where sepsis is occurring across the organization to better evaluate patient outcomes.
Those insights will continue to inform ongoing improvements to the alert system and response pathway, at UHN and beyond.
