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Published (Version of record)CC BY-NC-ND V4.0, Open Access
Published (Version of record)CC BY-NC-ND V4.0, Open
Journal article
Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the Implementation of a Pediatric Sepsis Pathway Within the Emergency Department
Critical Care Explorations, Vol.3(11), pp.1-14
2021
PMCID: PMC8577679
PMID: 34765981
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Abstract
OBJECTIVES: To evaluate the implementation of a pediatric sepsis pathway in the emergency department as part of a statewide quality improvement initiative in Queensland, Australia.
DESIGN: Multicenter observational prospective cohort study.
SETTING: Twelve emergency departments in Queensland, Australia.
PATIENTS: Children less than 18 years evaluated for sepsis in the emergency department. Patients with signs of shock, nonshocked patients with signs of organ dysfunction, and patients without organ dysfunction were assessed.
INTERVENTIONS: Introduction of a pediatric sepsis pathway.
MEASUREMENTS AND MAIN RESULTS: Process measures included compliance with and timeliness of the sepsis bundle, and bundle components. Process and outcome measures of children admitted to the ICU with sepsis were compared with a baseline cohort. Five-hundred twenty-three children were treated for sepsis including 291 with suspected sepsis without organ dysfunction, 86 with sepsis-associated organ dysfunction, and 146 with septic shock. Twenty-four (5%) were admitted to ICU, and three (1%) died. The median time from sepsis recognition to bundle commencement for children with septic shock was 56 minutes (interquartile range, 36–99 min) and 47 minutes (interquartile range, 34–76 min) for children with sepsis-associated organ dysfunction without shock; 30% (n = 44) and 40% (n = 34), respectively, received the bundle within the target timeframe. In comparison with the baseline ICU cohort, bundle compliance improved from 27% (n = 45) to 58% (n = 14) within 60 minutes of recognition and from 47% (n = 78/167) to 75% (n = 18) within 180 minutes of recognition (p < 0.05).
CONCLUSIONS: Our findings on the introduction of protocolized care in a large and diverse state demonstrate ongoing variability in sepsis bundle compliance. Although bundle compliance improved compared with a baseline cohort, continued efforts are required to ensure guideline targets and sustainability are achieved.
Details
- Title
- Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the Implementation of a Pediatric Sepsis Pathway Within the Emergency Department
- Creators
- Amanda Harley - University of QueenslandPaula Lister - Griffith UniversityPatricia Gilholm - University of QueenslandMichael Rice - Queensland HealthBala Venkatesh - University of QueenslandAmy N.B Johnston - Princess Alexandra HospitalDebbie Massey - Southern Cross UniversityAdam Irwin - Queensland Children’s HospitalKristen Gibbons - University of QueenslandLuregn J Schlapbach - University Children's Hospital Zurich
- Publication Details
- Critical Care Explorations, Vol.3(11), pp.1-14
- Publisher
- Lippincott Williams & Wilkins
- Grant note
- Supported, in part, by a grant from the Children’s Hospital Foundation Brisbane, Australia (to Dr. Schlapbach). Dr. Schlapbach was supported by a practitioner fellowship from the National Health and Medical Research Council of Australia (NHMRC) and by a grant from the Children’s Hospital Foundation. Dr. Irwin is supported by an NHMRC Investigator Fellowship (APP1197743). The Queensland Sepsis Collaborative was funded by Clinical Excellence Queensland.
- Identifiers
- 991012982347302368
- Copyright
- Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
- Academic Unit
- School of Health and Human Sciences; Faculty of Health; Nursing
- Language
- English
- Resource Type
- Journal article