AUDIT STANDARDS IN PAEDIATRIC SEVERE SEPSIS

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Abstract

Objectives & Background

Severe sepsis in the paediatric population is a rare, but serious condition that requires prompt recognition and management in the Emergency Department. Whereas severe sepsis in the adult population is being continuously monitored using standardized quality measures, data on performance in the paediatric population is sparse in our institution. We hypothesized that performance can be measured using available data sources. The aim of this study was to measure baseline performance using the RCEM adult-sepsis audit standards in the paediatric population with severe sepsis.

Methods

This is a single-centre descriptive study from a university hospital with 30,000 A&E-paediatric attendances per year. Data were collected from January 2012 through April 2015. Inclusion criteria were children (<16y) admitted through the A&E with direct transfer to paediatric ITU with evidence of sepsis in the A&E. Cases were identified by ICD diagnosis of sepsis upon discharge from PICU. We did not include transfers from other hospitals.

Methods

Baseline data was collected from the electronic patient system: Age, gender, pre-morbid conditions, as well as in-hospital mortality and length of stay (LOS). The RCEM standards for adult sepsis, as well as adapted measures, were extracted from the scanned hand written ED charts: Timing of bedside assessment by doctor, blood cultures, antibiotics, and fluids. Measurements of lactate and blood glucose. Monitoring of vital signs upon arrival, and documentation of urine dip and presumed focus of infection.

Results

We identified 19 cases of paediatric sepsis admitted through the A&E. 13 of 19 cases (68%) were male, median age was 70 days and 8 of 19 (42%) were born at term with no significant past medical history. Median LOS in hospital was 5 days, and all patients (100%) survived to discharge. Please see table for audit results.

Conclusion

Available data sources can be used to measure baseline performance in the paediatric population with severe sepsis. We did not fulfil any of the RCEM adult-sepsis audit standards. Timeliness of vital signs and administration of first fluid bolus seem to be amongst the biggest challenges in our institution. Further research is needed to investigate if continuous monitoring on these measures will improve performance.

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