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Pediatric Emergency Department Care for Septic Shock in Sub-Saharan Africa: Single-Center Outcomes Before-Vs.-After
Vanessa C Denny1, Justicia Amisah2, John Adabie Appiah2
1Department of Anesthesiology, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
A telesimulation program significantly reduced pediatric sepsis mortality in Ghana by improving timely interventions. The training was found to be acceptable and feasible for healthcare providers.
Area of Science:
- Global Health
- Pediatric Emergency Medicine
- Medical Simulation
Background:
- Sepsis is a major cause of preventable mortality in low-resource settings.
- Delays in recognition and treatment, coupled with limited training, worsen outcomes.
- Pediatric sepsis requires timely, critical interventions for survival.
Purpose of the Study:
- To evaluate the impact of a contextualized telesimulation and debriefing program on sepsis outcomes in children.
- To assess improvements in time-critical care processes for pediatric sepsis.
- To determine the acceptability and feasibility of the telesimulation program among healthcare providers.
Main Methods:
- A 12-month mixed-method, quasi-experimental (before-and-after) study was conducted.
- Pediatric emergency department providers participated in telesimulation using culturally adapted videos.
- Trained observers tracked time-critical interventions and patient outcomes pre- and post-intervention.
Main Results:
- Mortality decreased from 36% to 10% (OR 0.2; p=0.001) post-intervention.
- Odds of supplemental oxygen use (OR 2.4) and IV placement (OR 3.8) significantly increased.
- 44 out of 45 trainees found the program acceptable and feasible.
Conclusions:
- Contextualized telesimulation and debriefing are associated with reduced pediatric sepsis mortality.
- The program improved critical care processes and was well-received by healthcare teams.
- This intervention offers a feasible solution for enhancing pediatric sepsis care in resource-limited areas.
Objectives:
Sepsis is a leading cause of preventable death in low-resource settings, where delays in recognition and emergency department (ED) treatment are common. Limited access to training also contributes to poor outcomes. We hypothesized that a contextualized telesimulation and debriefing program would be associated with better sepsis-related outcomes and time-critical care processes in children presenting to our center in Kumasi, Ghana. We also determined the program's acceptability and feasibility in our clinical providers.
Design:
We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys.
Setting:
Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds.
Participants:
ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock.
Interventions:
None.
Measurements And Main Results:
Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible.
Conclusions:
In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.
