Severe sepsis and septic shock continue to cause significant morbidity and mortality in children worldwide. 1 To that end, the World Health Organization, along with its decision-mak-ing body the World Health Assembly, adopted a resolution on May 24, 2017, to improve the prevention, diagnosis, and management of sepsis-a crucial step in reducing the global burden of sepsis. 2 The prevalence of pediatric severe sepsis and septic shock has been increasing; however, advances are being Keywords ► EHR workflow design ► emergency medicine ► screening tool ► pediatric sepsis AbstractObjective This article describes the method of integrating a manual pediatric emergency department sepsis screening process into the electronic health record that leverages existing clinical documentation and keeps providers in their current, routine clinical workflows. Methods Criteria in the manual pediatric emergency department sepsis screening tool were mapped to standard documentation routinely entered in the electronic health record. Data elements were extracted and scored from the medical history, medication record, vital signs, and physical assessments. Scores that met a predefined sepsis risk threshold triggered interruptive system alerts which notified emergency department staff to perform sepsis huddles and consider appropriate interventions. Statistical comparison of the new electronic tool to the manual process was completed by a two-tail paired t-test. Results The performance of the pediatric electronic sepsis screening tool was evaluated by comparing flowsheet row documentation of the manual, sepsis alert process against the interruptive system alert instance of the electronic sepsis screening tool. In an 8-week testing period, the automated pediatric electronic sepsis screening tool identified 100% of patients flagged by the manual process (n ¼ 29), on average, 68 minutes earlier.Conclusion Integrating a manual sepsis screening tool into the electronic health record automated identification of pediatric sepsis screening in a busy emergency department. The electronic sepsis screening tool is as accurate as a manual process and would alert bedside clinicians significantly earlier in the emergency department course. Deployment of this electronic tool has the capability to improve timely sepsis detection and management of patients at risk for sepsis without requiring additional documentation by providers.
Introduction: 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.
Background:Presentation of sepsis is dependent on synthesis of varied clinical information, making identification of septic patients challenging. Common practice is to identify sepsis through a manual screening tool, which may miss opportunities for early sepsis detection. Electronic screening efforts requiring additional documentation by providers may not integrate easily into provider workflow.Objectives:To develop an automated sepsis risk screening tool in the electronic health record that would accurately identify patients at risk for sepsis without requiring additional documentation.Methods:Criteria in the manual screening tool were mapped to standard documentation routinely entered in the electronic health record (Epic Systems, Corp.). Data elements were scored electronically at arrival and every 15 minutes during their encounter from the medical history, medication record, vital signs, and physical assessment (Fig. 1). Scores that exceeded a predefined sepsis risk threshold triggered a Best Practice Advisory, which alerted bedside staff to perform sepsis huddles and consider appropriate interventions. Statistical comparison of the automated tool to the manual process was completed by two-tail paired t test.Results:In an 8-week testing period, the automated sepsis risk screening tool identified 100% of patients flagged by the manual process (N = 29) (Table 1). The electronic tool identified sepsis patients, on average, 68 minutes earlier. This was statistically significant (P < 0.001).Conclusions/Implications:The automated sepsis risk screening tool is as accurate as a validated manual process and alerted bedside clinicians earlier. Deployment has potential to improve timely sepsis detection and management of patients without requiring additional documentation by provider.
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