Data plays a key role in helping this hospital document the treatment of sepsis patients.
Sepsis is a difficult condition to detect and treat. A multidisciplinary team at Seattle Children's Hospital looked for ways to help Emergency Department (ED) staff members improve the diagnosis and tracking of patients who were at risk for sepsis.
At the 2018 Quality and Safety in Children's Health Conference, data analysts from Seattle Children's outlined methods for defining the ED population and identifying areas for data improvement. The team created a data warehouse that structures information to identify potential septic patients. "Not only are we impacting patient care, but we can also do quality analysis and quality improvement research on the patients we have collected this information on," says Jennifer Phillips, M.P.H, senior data analyst.
As part of its effort to fight sepsis, Seattle Children's participates in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative. The data warehouse incorporates the variables needed for data collection and analysis by IPSO.
The hospital team grounded its work with three specific aims:
- Develop and implement an electronic identification tool. When the project started, the screening tool used by clinicians was optional. "Not only was it optional, if it was used, it was used very little," says Holly Clifton, data consultant. Sepsis screening is now part of intake when kids present to the ED with a fever or concern for infection. Screenings were recorded on paper, but the new method makes the workflow part of the electronic medical record.
- Implement clinical standard work pathway for patients with sepsis in the ED and inpatient setting. Inpatient information displayed on the ED dashboard revealed areas for growth. Clifton's team dug into data and discovered not all of the recorded temperatures were documented by nurses in the same place. That meant not all of it was added to data collection. "We still have work to do," says Clifton. "The changes we have made by adding decision support and mandatory processes are showing improvements. The number of patients screened has risen from around 15 percent to 75 or 79 percent."
- Ensure appropriate escalation of care and PICU involvement. While the hospital had a Rapid Response Team plan, it coded another step in the computer information system that asked if the patient should be on the sepsis pathway.
The hospital's goal is to use the data to predict and prevent sepsis. "We want to make sure that not only are we treating these patients but that we are documenting the treatment of these patients," says Phillips. "It was the implementation, the education and making the use of the screening tool mandatory that helped us make progress."
The next step under consideration is documenting huddles. The data team plans on hard-coding documentation into their clinical information systems.
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