Bundled Care to Reduce Sepsis Mortality: The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative

Area of Science:

• Pediatric critical care medicine
• Quality improvement initiatives
• Sepsis management

Background:

• Sepsis care bundles are crucial for improving outcomes in pediatric patients.
• Previous guidelines emphasized very rapid interventions, potentially creating challenges in real-world application.
• Optimizing the timing of sepsis care elements is essential for reducing mortality.

Purpose of the Study:

• To enhance the utilization of a pediatric sepsis care bundle.
• To decrease 3- and 30-day sepsis-attributable mortality.
• To identify specific care bundle elements associated with improved patient outcomes.

Main Methods:

• A quality improvement collaborative (Improve Pediatric Sepsis Outcomes) involving 40 children's hospitals from January 2017 to March 2020.
• Analysis of two cohorts: IPSO Suspected Sepsis (ISS) and IPSO Critical Sepsis (ICS).
• Comparison of an original bundle (recognition, fluids < 20 min, antibiotics < 60 min) with a modified, time-liberalized bundle (recognition, fluids < 60 min, antibiotics < 180 min).

Main Results:

• Over 24,518 ISS and 12,821 ICS cases were analyzed.
• Modified bundle compliance increased over time in both cohorts.
• In the ISS cohort, 30-day mortality decreased by 35.7% (1.4% to 0.9%).
• In the ICS cohort, the modified bundle was associated with a significant reduction in 30-day mortality (4.75% to 2.4%), unlike the original bundle.

Conclusions:

• Timely sepsis treatment is vital for reducing pediatric mortality.
• A time-liberalized sepsis care bundle demonstrated greater effectiveness in reducing sepsis-attributable mortality compared to a stricter, original bundle.
• The findings support the adoption of modified, evidence-based sepsis care bundles in pediatric settings.