Related Experiment Videos
Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the
Amanda Harley1,2,3,4, Paula Lister2,5,6, Patricia Gilholm2
1School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Qld, Australia.
Insights
Implementing a pediatric sepsis pathway in Queensland emergency departments improved sepsis bundle compliance. However, variability persists, requiring ongoing efforts to meet guideline targets for pediatric sepsis care.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Infectious Diseases
Background:
- Sepsis is a life-threatening condition in children, necessitating rapid diagnosis and treatment.
- Standardized care pathways, like the pediatric sepsis pathway, aim to improve outcomes.
- Statewide quality improvement initiatives are crucial for disseminating best practices.
Purpose of the Study:
- To evaluate the implementation and effectiveness of a pediatric sepsis pathway across multiple emergency departments.
- To assess compliance with sepsis bundle components and timeliness of care.
- To compare outcomes with a historical cohort before pathway implementation.
Main Methods:
- A multicenter observational prospective cohort study was conducted in 12 emergency departments in Queensland, Australia.
- The study included children under 18 years evaluated for sepsis, categorizing them by shock status and organ dysfunction.
- Data on process measures (bundle compliance, timeliness) and outcome measures (ICU admission, mortality) were collected and analyzed.
Main Results:
- 523 children were treated for sepsis; 24 (5%) were admitted to ICU, and 3 (1%) died.
- Median time to bundle commencement for septic shock was 56 minutes; 30% received care within the target timeframe.
- Bundle compliance improved significantly compared to a baseline cohort, from 27% to 58% within 60 minutes and 47% to 75% within 180 minutes (p < 0.05).
Conclusions:
- Protocolized care for pediatric sepsis in a large, diverse state showed improved bundle compliance.
- Variability in sepsis bundle compliance remains a challenge.
- Sustained efforts are necessary to achieve and maintain guideline targets for pediatric sepsis management.
Objectives:
To evaluate the implementation of a pediatric sepsis pathway in the emergency department as part of a statewide quality improvement initiative in Queensland, Australia.
Design:
Multicenter observational prospective cohort study.
Setting:
Twelve emergency departments in Queensland, Australia.
Patients:
Children less than 18 years evaluated for sepsis in the emergency department. Patients with signs of shock, nonshocked patients with signs of organ dysfunction, and patients without organ dysfunction were assessed.
Interventions:
Introduction of a pediatric sepsis pathway.
Measurements And Main Results:
Process measures included compliance with and timeliness of the sepsis bundle, and bundle components. Process and outcome measures of children admitted to the ICU with sepsis were compared with a baseline cohort. Five-hundred twenty-three children were treated for sepsis including 291 with suspected sepsis without organ dysfunction, 86 with sepsis-associated organ dysfunction, and 146 with septic shock. Twenty-four (5%) were admitted to ICU, and three (1%) died. The median time from sepsis recognition to bundle commencement for children with septic shock was 56 minutes (interquartile range, 36-99 min) and 47 minutes (interquartile range, 34-76 min) for children with sepsis-associated organ dysfunction without shock; 30% (n = 44) and 40% (n = 34), respectively, received the bundle within the target timeframe. In comparison with the baseline ICU cohort, bundle compliance improved from 27% (n = 45) to 58% (n = 14) within 60 minutes of recognition and from 47% (n = 78/167) to 75% (n = 18) within 180 minutes of recognition (p < 0.05).
Conclusions:
Our findings on the introduction of protocolized care in a large and diverse state demonstrate ongoing variability in sepsis bundle compliance. Although bundle compliance improved compared with a baseline cohort, continued efforts are required to ensure guideline targets and sustainability are achieved.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:20Acute Kidney Injury V: Interprofessional Care
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption