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Optimizing Recognition and Management of Patients at Risk for Infection-Related Decompensation Through Team-Based
Insights
Improving pediatric sepsis care requires more than electronic alerts. Combining alert systems with team communication and standardized workflows significantly enhances timely interventions for children at risk of infection-related decompensation (IRD).
Area of Science:
- Pediatrics
- Critical Care Medicine
- Health Informatics
Background:
- Pediatric sepsis is a major cause of child mortality.
- Electronic alert systems show promise for early sepsis recognition but often fall short in ensuring timely interventions due to clinical complexity and communication gaps.
Purpose of the Study:
- To enhance the timely critical treatment of pediatric patients at risk for infection-related decompensation (IRD).
- To improve interdisciplinary team-based communication and standardize treatment workflows in pediatric emergency care.
Main Methods:
- A quality improvement project was implemented in the emergency department.
- Evaluated children at risk for IRD using the Children at High Risk Alert Tool (CAHR-AT).
- Improvements included CAHR-AT implementation, clinical coassessment, visual cues, huddles, and standardized order sets.
Main Results:
- Huddle compliance increased from 7.8% to 65.3% post-visual cue activation (p < .001).
- Antibiotic administration by 3 hours increased from 37.9% to 50.7% (p < .0001).
- Fluid bolus administration by 3 hours increased from 49.0% to 55.2% (p = .001).
Conclusions:
- Electronic alert tools alone are insufficient for improving timely treatment in high-risk pediatric patients.
- Combining alert systems with team communication, standardized reassessment, and treatment workflows is crucial for enhancing care quality.
Introduction:
Pediatric sepsis is a leading cause of death among children. Electronic alert systems may improve early recognition but do not consistently result in timely interventions given the multitude of clinical presentations, lack of treatment consensus, standardized order sets, and inadequate interdisciplinary team-based communication. We conducted a quality improvement project to improve timely critical treatment of patients at risk for infection-related decompensation (IRD) through team-based communication and standardized treatment workflow.
Methods:
We evaluated children at risk for IRD as evidenced by the activation of an electronic alert system (Children at High Risk Alert Tool [CAHR-AT]) in the emergency department. Outcomes were assessed after multiple improvements including CAHR-AT implementation, clinical coassessment, visual cues for situational awareness, huddles, and standardized order sets.
Results:
With visual cue activation, initial huddle compliance increased from 7.8% to 65.3% ( p < .001). Children receiving antibiotics by 3 hours postactivation increased from 37.9% pre-CAHR-AT to 50.7% posthuddle implementation ( p < .0001); patients who received a fluid bolus by 3 hours post-CAHR activation increased from 49.0% to 55.2% ( p = .001).
Conclusions:
Implementing a well-validated electronic alert tool did not improve quality measures of timely treatment for high-risk patients until combined with team-based communication, standardized reassessment, and treatment workflow.
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