Plan-Do-Study-Act Methodology: Refining an Inpatient Pediatric Sepsis Screening Process
Kathryn E Nuss1,2,3, Jillian S Kunar1,4, Erin A Ahrens5
1Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio.
Insights
Optimizing sepsis screening tools and implementing huddle processes significantly reduced pediatric intensive care unit transfers for sepsis. This quality improvement initiative improved patient outcomes by enhancing early sepsis detection and management.
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
Abstract:
Pediatric sepsis remains a leading cause of death of children in the United States. Timely recognition and treatment are critical to prevent the onset of severe sepsis and septic shock. Electronic screening tools aid providers in identifying patients at risk for sepsis. Our overall project goal was to decrease the number of sepsis-related emergent transfers to the pediatric intensive care unit by optimizing sepsis screening tools, interruptive alerts, and a new paper tool and huddle process using Plan-Do-Study-Act (PDSA) methodology.
Methods:
Our team utilized historical data to develop inpatient electronic sepsis screening tools to identify pediatric patients at risk for sepsis. Using PDSA iterative cycles over 3 months, we tested the design of an interruptive alert, paper tool, and a new sepsis huddle process.
Results:
During the PDSA, the clinical teams conducted huddles on all patients who received an interruptive alert (n = 35). Eighty percent of huddles had a 5.7 minute average response time and an average duration of 5.3 minutes. Completion of the huddle outcome notes occurred 83% of the time, and 70% had feedback related to the alert, paper form, and huddle process. The number of days between sepsis-related emergent transfers to the pediatric intensive care unit increased from a median of 17.5 to 57.5 days, with a single point as high as 195 days between events.
Conclusions:
The inpatient sepsis team learned valuable lessons using PDSA methodology. The results of the iterative cycles allowed the team to optimize and refine the tests of change. System-wide implementation benefited from the application of this quality improvement tool.
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