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A prospective quality improvement study in the emergency department targeting paediatric sepsis
Elliot Long1, Franz E Babl1, Eleanor Angley2
1Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia Department of Pediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Insights
Quality improvement initiatives in pediatric emergency departments significantly reduced sepsis management times and hospital stays. This study demonstrates improved sepsis care processes and patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Quality Improvement
- Infectious Diseases
Background:
- Pediatric sepsis initiatives aim to improve patient outcomes, but their impact on processes and results is often unclear.
- Previous quality improvement efforts in pediatric emergency departments showed process improvements but lacked definitive outcome data.
Purpose of the Study:
- To evaluate and enhance sepsis management processes within a pediatric emergency department.
- To assess the subsequent impact of these improved processes on patient outcomes, specifically hospital length of stay.
Main Methods:
- A prospective observational cohort study was conducted involving children (0-18 years) diagnosed with sepsis in a pediatric emergency department.
- Key interventions targeted timely antibiotic administration, blood gas sampling during cannulation, and rapid fluid resuscitation.
- The primary outcome measure was hospital length of stay, with process metrics also tracked.
Main Results:
- The study enrolled 102 patients pre-intervention and 113 post-intervention.
- Significant improvements were observed: time to antibiotics decreased from 55 to 19 minutes, venous blood gas collection increased from 60% to 79%, and rapid fluid administration rose from 31% to 84%.
- Median hospital length of stay decreased from 96 hours to 80 hours (p=0.02), persisting after confounder correction.
Conclusions:
- Implementing quality improvement methodologies effectively enhanced pediatric sepsis management in the emergency department.
- These process improvements were associated with a significant reduction in hospital length of stay for pediatric sepsis patients.
Objective:
Quality improvement sepsis initiatives in the paediatric emergency department have been associated with improved processes, but an unclear effect on patient outcome. We aimed to evaluate and improve emergency department sepsis processes and track subsequent changes in patient outcome.
Study Design:
A prospective observational cohort study in the emergency department of The Royal Children's Hospital, Melbourne. Participants were children aged 0-18 years of age meeting predefined criteria for the diagnosis of sepsis. The following shortcomings in management were identified and targeted in a sepsis intervention: administration of antibiotics and blood sampling for a venous gas at the time of intravenous cannulation, and rapid administration of all fluid resuscitation therapy. The primary outcome measure was hospital length of stay.
Results:
102 patients were enrolled pre-intervention, 113 post-intervention. Median time from intravenous cannula insertion to antibiotic administration decreased from 55 min (IQR 27-90 min) pre-intervention to 19 min (IQR 10-32 min) post-intervention (p≤0.01). Venous blood gas at time of first intravenous cannula insertion was performed in 60% of patients pre-intervention vs 79% post-intervention (p≤0.01). Fluids were administered using manual push-pull or pressure-bag methods in 31% of patients pre-intervention and 84% of patients post-intervention (p≤0.01). Median hospital length of stay decreased from 96 h (IQR 64-198 h) pre-intervention to 80 h (IQR 53-167 h) post-intervention (p=0.02). This effect persisted when corrected for unequally distributed confounders between pre-intervention and post-intervention groups (uncorrected HR: 1.36, 95% CI 1.04 to 1.80, p=0.02; corrected HR: 1.34, 95% CI 1.01 to 1.80, p=0.04).
Conclusions:
Use of quality improvement methodologies to improve the management of paediatric sepsis in the emergency department was associated with a reduction in hospital length of stay.
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