Development of a Quality Improvement Learning Collaborative to Improve Pediatric Sepsis Outcomes

Abstract

Pediatric sepsis is a major public health problem. Published treatment guidelines and several initiatives have increased adherence with guideline recommendations and have improved patient outcomes, but the gains are modest, and persistent gaps remain. The Children’s Hospital Association Improving Pediatric Sepsis Outcomes (IPSO) collaborative seeks to improve sepsis outcomes in pediatric emergency departments, ICUs, general care units, and hematology/oncology units. We developed a multicenter quality improvement learning collaborative of US children’s hospitals. We reviewed treatment guidelines and literature through 2 in-person meetings and multiple conference calls. We defined and analyzed baseline sepsis-attributable mortality and hospital-onset sepsis and developed a key driver diagram (KDD) on the basis of treatment guidelines, available evidence, and expert opinion. Fifty-six hospital-based teams are participating in IPSO; 100% of teams are engaged in educational and information-sharing activities. A baseline, sepsis-attributable mortality of 3.1% was determined, and the incidence of hospital-onset sepsis was 1.3 cases per 1000 hospital admissions. A KDD was developed with the aim of reducing both the sepsis-attributable mortality and the incidence of hospital-onset sepsis in children by 25% from baseline by December 2020. To accomplish these aims, the KDD primary drivers focus on improving the following: treatment of infection; recognition, diagnosis, and treatment of sepsis; de-escalation of unnecessary care; engagement of patients and families; and methods to optimize performance. IPSO aims to improve sepsis outcomes through collaborative learning and reliable implementation of evidence-based interventions.

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review

“…Table 5 reports the main characteristics of the neonatal CCDS systems. Notably, most studies investigated early-onset sepsis (15/18, 83%) using the neonatal early-onset sepsis risk calculator developed by the Kaiser Permanente team [ 87 - 89 ] (14/18, 78%).…”

“…In particular, we found great variability across the clinical criteria used for pediatric sepsis identification, with 18 different clinical criteria used in numerous combinations across 8 studies ( Table 3 ). Furthermore, a range of gold standard definitions was applied, of which the most common was clinician discretion rather than published tools [ 12 , 85 , 86 ], highlighting the lack of a consensus definition and tool for pediatric sepsis identification. Hospital settings varied widely between studies, and numerous related interventions were implemented alongside the pediatric CCDS, with few similarities.…”

Using Aggregate Vasoactive-Inotrope Scores to Predict Clinical Outcomes in Pediatric Sepsis

“…Patient electronic medical records were initially identified by the CW clinical sepsis alert and filtered for those patients who received vasoactive medications for the treatment of severe sepsis during their hospitalization (12,13). Charts were then manually reviewed to determine if patients met the appropriate inclusion criteria.…”

Barriers and Proposed Solutions to a Successful Implementation of Pediatric Sepsis Protocols

“…One of the KDD primary drivers was engagement of patients and families. This bundle was composed by the following items: (1) include family in planning and implementing teams; (2) family-activated rapid response system; (3) real-time discussions with family members to explain what happened, provide education, answer questions, and identify concerns about the patient's care; (4) create or engage organization, service line, and/or care setting patient and family engagement resources; (5) ensure common understanding of patient and family engagement across the organization ( 25 ).…”