Early Recognition of Sepsis among Inpatients in Pediatric Critical Care and Acute Care Areas

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Abstract

Project Aim:

Develop, test, and implement inpatient clinical decision support tools (Best Practice Alerts; BPA) for early recognition of sepsis to improve time from physiologic sepsis to recognition, and timeliness of evidence-based care, with the ultimate goals of reducing mortality and morbidity.

Background:

No valid and reliable sepsis screening tools for hospitalized children exist. The Pediatric Septic Shock collaborative, focused on Emergency Centers, demonstrated reduced mortality with early intervention and improved adherence to evidence-based care bundles. Setting: large quaternary children’s hospital, average monthly severe sepsis volume: 148 children, 6 deaths.

Methods:

Existing pediatric sepsis screens were identified via literature review, Epic UserWeb, and Children’s Hospital Association Improving Pediatric Sepsis Outcomes Collaborative website. Our Emergency Center sepsis screen was selected as the base for our inpatient tools. Separate scoring criteria were developed for use in the Critical Care areas and Acute Care/Hematology-Oncology/Bone Marrow Transplant areas (Fig. 1).

Results:

The sepsis screening algorithms were implemented in the background of the electronic medical record, allowing performance testing in our populations before becoming visible to the end-user. Initial results of a 3-day test period of screening with 8-hour lockout are in Table 1.

Discussion:

The number of activations were not excessive. Multiple revisions to the BPA build were required due to the paucity of component details in the reporting for population analysis; however, these enriched data are pending.

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