A prospective quality improvement study in the emergency department targeting paediatric sepsis

Abstract

Use of quality improvement methodologies to improve the management of paediatric sepsis in the emergency department was associated with a reduction in hospital length of stay.

Effect of Fluid Bolus Therapy on Extravascular Lung Water Measured by Lung Ultrasound in Children With a Presumptive Clinical Diagnosis of Sepsis

“…The study population was a convenience sample and may have systematically excluded some patient groups. We found, however, a similar range of ages, initial and final diagnoses, and rates of positive bacteriologic diagnoses as in previous sepsis audits performed in our unit using the same inclusion criteria . All participants had an initial presumptive diagnosis of sepsis, yet some had an alternative final (discharge) diagnosis.…”

Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis

“…The study included a convenience sample of participants, and may have systematically excluded some participant groups. As a pragmatic study, however, the study population was thought to be representative of the spectrum of illness encountered in clinical practice, and had similar characteristics to previous clinical audits using the same inclusion criteria . The data from several participants were uninterpretable and excluded from analysis, which may have introduced a source of bias; however, the number of uninterpretable images was in keeping with previous studies .…”

“…As a pragmatic study, however, the study population was thought to be representative of the spectrum of illness encountered in clinical practice, and had similar characteristics to previous clinical audits using the same inclusion criteria. 45 The data from several participants were uninterpretable and excluded from analysis, which may have introduced a source of bias;…”

Update on pediatric sepsis: a review

“…With their vigorous intervention to the ED staff, adherence to fluids, vasoactive agents, and the total bundle all improved and finally reached 100% and remained nearly 100% thereafter [112]. Long et al prospectively conducted the same sort of quality improvement intervention study, focusing on venous blood gas sampling, timely fluid resuscitation, and antibiotic administration [113]. They achieved the significant reduction of time to intravenous access, antibiotic administration, and fluid administration, and more importantly, significantly shorter hospital length of stay (96 h in pre-intervention vs. 80 h in post-intervention; hazard ratio 1.36, 95% CI 1.04–1.80) [113].…”

“…Long et al prospectively conducted the same sort of quality improvement intervention study, focusing on venous blood gas sampling, timely fluid resuscitation, and antibiotic administration [113]. They achieved the significant reduction of time to intravenous access, antibiotic administration, and fluid administration, and more importantly, significantly shorter hospital length of stay (96 h in pre-intervention vs. 80 h in post-intervention; hazard ratio 1.36, 95% CI 1.04–1.80) [113]. A couple of other retrospective cohort studies suggested the beneficial effect of protocolized initial management for reduced complication rate of acute kidney injury [114] and some organ dysfunctions [115].…”