Here's how one hospital has driven its sepsis detection rate to nearly 100 percent.
When a team at The Children's Hospital of Philadelphia (CHOP) decided to harness the power of the hospital's various clinical departments and disciplines to fight pediatric sepsis, it led to a breakthrough in fighting the deadly disease. A new pediatric sepsis program was born, which ultimately would drive the hospital's sepsis detection rate to nearly 100 percent.
"It became clear there was increasing momentum around different aspects of sepsis care," says Scott Weiss, M.D., M.S.C.E., a pediatric intensivist at CHOP. "There was an opportunity to develop a more formalized program to bring people together so we could learn from each other, support each other, avoid duplication of each other's work and create a center of excellence for pediatric sepsis at CHOP."
The program launch
Under the co-directorship of Weiss, Julie Fitzgerald, M.D, Ph.D., a pediatric intensivist in the Department of Anesthesiology and Critical Care Medicine and the Pediatric Intensive Care Unit at CHOP, and Fran Balamuth, M.D., Ph.D., the associate director of research and an attending physician in the Division of Emergency Medicine at CHOP, the Pediatric Sepsis Program launched last month following several years of research. According to the hospital, it is the first comprehensive center focused on pediatric sepsis in the United States.
Improved outcomes through early detection
In the Emergency Department (ED) at CHOP, sepsis was initially detected by clinical judgment only, since electronic alerts could pick up many false positives. Analyses of this approach found about 20 percent of patients with sepsis were missed, leading the team to further explore electronic alert usage.
As a result, CHOP built a two-stage alert into its electronic health record. The alert triggers if the patient has either low blood pressure or a high heart rate—common signs of sepsis. This prompts the triage nurse to answer a series of clinical questions regarding the patient's condition, which can lead to a "sepsis huddle"—a senior ED attending physician comes to the patient's bedside of the patient and decides whether the child needs to be treated based on the sepsis protocol.
Sepsis detection at CHOP rose from 83 percent at the program's onset to 96 percent following its implementation, and that rate of detection has held steady for the three years since. Early detection is key: CHOP found that patients who were treated within this sepsis program had better clinical outcomes than those who were missed.
Establishing a medical home
The impact of the program goes beyond clinical outcomes. According to Weiss, the heightened multidisciplinary focus on sepsis creates a de facto medical home for its patients, not unlike the relationships cancer patients have with the oncology department or lupus patients have with the rheumatology team.
"When families are struggling with a child with sepsis, they don't really have a 'home' to support them," Weiss says. "We have taken the perspective that because sepsis is a multi-organ system disease, it needs a home. We're hoping the pediatric sepsis program at CHOP can provide that over time for our families while they're in the hospital, as well as when they leave."
Experts together under one "umbrella"
With many other children's hospitals around the country emphasizing the importance of early detection and intervention of pediatric sepsis, Weiss says CHOP is not the only one tackling the disease. But what the team says sets their program apart is the "umbrella" approach, bringing experts from across many disciplines to battle a common foe.
"Sepsis affects all the parts of the body and can affect any child—it's a really complicated disease," Balamuth says. "It requires us to reach across lines that are sometimes arbitrarily drawn, but because of those collaborative efforts we've been able to build something that hopefully will continue to impact kids for years to come."
CHOP, who is also a participant in CHA's national Improving Pediatric Sepsis Outcomes collaborative, will support ongoing efforts in sepsis research, clinical care and quality improvement. Balamuth says the team will continue to fine-tune the alert process and education of staff members. In addition, the program calls for expansion into new areas, including sepsis screening in CHOP's satellite EDs and developing follow-up programs for sepsis survivors.
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