Plan-Do-Study-Act Methodology: Refining an Inpatient Pediatric Sepsis Screening Process.

Area of Science:

• Pediatric critical care medicine
• Healthcare quality improvement
• Infectious disease management

Background:

• Pediatric sepsis is a major cause of child mortality in the U.S.
• Early recognition and treatment are vital to prevent severe sepsis and septic shock
• Electronic screening tools assist in identifying at-risk pediatric patients

Purpose of the Study:

• To decrease sepsis-related emergent transfers to the pediatric intensive care unit
• To optimize sepsis screening tools, interruptive alerts, and huddle processes
• To apply Plan-Do-Study-Act (PDSA) methodology for quality improvement

Main Methods:

• Developed inpatient electronic sepsis screening tools using historical data
• Employed PDSA iterative cycles over 3 months
• Tested interruptive alerts, paper tools, and a sepsis huddle process

Main Results:

• Huddles were conducted for all 35 patients receiving alerts, with 80% having a rapid average response time (5.7 min)
• Outcome notes were completed 83% of the time, with 70% providing feedback on the new processes
• Median days between sepsis-related emergent transfers to the PICU increased from 17.5 to 57.5 days

Conclusions:

• PDSA methodology provided valuable insights for optimizing sepsis screening and intervention processes
• Iterative testing allowed for refinement of the implemented changes
• System-wide application of this quality improvement approach yielded significant benefits