Sepsis strikes approximately 750,000 people in the US and is responsible for more than 215,000 deaths. Mortality remains high at 25-50% at a cost of $17 billion each year. These figures suggest that control and recognition of sepsis is relatively poor and there are a number of initiatives in place to try and rectify this.

One novel approach to this using interactive case scenarios provides a practical approach to early sepsis identification and application of evidence-based management (best practice) using Stanford’s Sepsis Guidelines.

This program is called Septris and turns management of septic patients into a game designed to teach a range of important points regarding the management and treatment of sepsis.

Furthermore, the Stanford University School of Medicine has designated this material for a maximum of 2 AMA Category 1 Credits although physicians should only claim only the credit commensurate with the extent of their participation in the activity.

The format of the interactive case scenarios take the form of a game. This game was written in HTML5 which means that it is accessible from most modern mobile devices as well as a range of browsers. In Septris, the idea is to heal all of the patients who are progressively deteriorating.

As their health decreases, so the patients move toward the bottom of the screen whereas improving their condition causes them to move up the screen. Reaching either screen limit will either result in death or discharge.

Selecting a patient allows you to view their vitals, history and lab results as well as allowing you to apply a range of treatments to the patient. The values are dynamic and will change as your patient becomes better or worse. If you succesfully treat a patient then you are presented with a question which you need to correctly answer  in order to qualify for CME credit. The specific learning objectives are detailed below:

  • Classify epidemiology of sepsis syndrome and differentiate between the different forms of sepsis syndromes (simple, severe and septic shock).
  • Integrate best evidence practices, clinical expertise and diagnostic test results for early identification and optimal management of septic states using Stanford’s Sepsis Guidelines and order sets.
  • Demonstrate strategies to apply Stanford Sepsis Guidelines including fluid resuscitation and transfer of patient with sepsis to a higher level of care.
  • Describe priority actions for establishing and implementing early goal directed therapies for the septic patients along the continuum of care.
  • Develop and apply interpersonal and communication skills related to early sepsis identification and management of sepsis states when working with other healthcare teams. (e.g. SBAR with identification).



The concept of an interactive game to train healthcare providers is a new and interesting approach to try and change the status quo. Gamfication of healthcare has seen excellent successes in improving patient education and medication compliance. The proliferation of mobile devices and internet connectivity mean new learning methods can be devised to try improve learning and understanding.

iMedicalApps was in touch with Lisa Shieh, one of the lead academics involved in the development of Septris:

What first prompted you to use the concept of an game to train healthcare professionals?

Lisa Shieh: We used the game concept to develop something new and different.  The traditional CME course is usually a day or two of didactic lectures. We wanted to create a learning game that physicians could play anywhere- waiting in line, in the classroom, at home, etc.  We also wanted to make it “addictive” enough so that physicians keep on going back to it.  The scoring is to foster the competitive spirit in people.  The dropping patients give it a sense of urgency. The quizes and tips are to reinforce our learning objectives.

What advantages do you think interactive games offer over more traditional CME courses?

Lisa Shieh: We believe interactive games actually help physicians to remember more. A case based format (like real patients) is easier to remember than reading a chapter in a textbook.  Our pilots with students have been very promising.  They continue to play even after the session is over- to “save” the patient.

Are there any plans to expand this type of professional education beyond Septris?

Lisa Shieh: We hope this game provides the platform for other medical topics.  We are in the process of exploring this.  We also plan to conduct a research study to see if physicians learn more from this format than other types of teaching methods