{"stable_id":"5df4a75ec00584bd","slug":"johns-hopkins-trews-sepsis","company":"Johns Hopkins Health System","workflow_name":"TREWS provider-confirmed early warning","function_code":"clinical_ops","pattern_codes":["creator_to_judge"],"changed_assumption":"An alert only changes care when a clinician confirms it quickly.","evidence_strength":"verified","publication_tier":"showcase","freshness":"current","reviewed_at":"2026-08-23","updated_at":"2026-08-22","source_quality_summary":"2 peer reviewed; publication outcomes are verified.","caveat_summary":"Observational association despite adjustment.","freshness_caveat":null,"workflow_summary":{"before":[{"actor":"Bedside physician or advanced-practice provider","action":"Recognizes possible sepsis through ordinary EHR review and clinical presentation.","actor_type":"human"},{"actor":"Care team","action":"Orders antibiotics and other treatment when sepsis is recognized.","actor_type":"human"}],"hinge":"An alert only changes care when a clinician confirms it quickly.","after":[{"actor":"TREWS","action":"Continuously monitors EHR data and passively displays a clickable alert icon when criteria are met.","actor_type":"system"},{"actor":"Bedside provider","action":"Evaluates the analysis and confirms or dismisses sepsis; timely confirmation initiates treatment sooner.","actor_type":"system"}],"decision_mode":"shared","decision_marker":"Human moves from creator to judge"},"before":[{"order":1,"actor":"Bedside physician or advanced-practice provider","action":"Recognizes possible sepsis through ordinary EHR review and clinical presentation.","handoff_to":"Antibiotic-order and treatment workflow","control":"Clinical judgment; the study does not decompose a single conventional recognition queue."},{"order":2,"actor":"Care team","action":"Orders antibiotics and other treatment when sepsis is recognized.","handoff_to":"Patient care","control":"Human clinical authority and sepsis protocol."}],"after":[{"order":1,"actor":"TREWS","action":"Continuously monitors EHR data and passively displays a clickable alert icon when criteria are met.","handoff_to":"Bedside provider alert queue","control":"The provider may open, confirm, dismiss, or leave the alert unaddressed."},{"order":2,"actor":"Bedside provider","action":"Evaluates the analysis and confirms or dismisses sepsis; timely confirmation initiates treatment sooner.","handoff_to":"Care team","control":"Provider retains diagnosis and treatment rights; three-hour response timing is the evaluated hinge."}],"decision_rights":"Provider owns diagnosis and treatment.","exception_path":"Dismissed alerts remain under ordinary surveillance.","removed_work":["Unassisted continuous chart surveillance"],"outcomes":[{"metric":"Time to antibiotic","baseline":"Late/dismissed/unaddressed alert","result":"1.85 hours earlier when confirmed within three hours","period":"Two-year deployment","scale":"9,805 sepsis cases; five hospitals","attribution_caveat":"Observational association despite adjustment.","evidence_label":"verified"}],"executive_lesson":"Adoption and response time are part of model performance.","anti_pattern":"Do not present association as randomized causality.","questions_for_leaders":["Where is the operating threshold set and who can override it?","What measured result would trigger rollback or retraining?","Which residual decisions must remain human-owned?"],"collections":["human-still-decides","regulated-autonomy"],"bundle_version":"1.0.0","bundle_fingerprint":"sha256:c23c6cc2b88153d008ea8fda928f632ce0011fc2d4c5036672a16e5d895bab93","canonical_url":"https://brianletort.ai/transformations/johns-hopkins-trews-sepsis"}