Optimizing Performance: Emergency Department Sepsis Champions: Past, Present, and Future

Abstract

Background:

Delays in recognition of sepsis and timely administration of fluids and antibiotics are significant barriers within pediatric emergency departments (ED).

Objectives:

To improve care for patients identified at risk for sepsis.

Methods:

In 2014, the ED at a large urban pediatric medical center created a unit-based sepsis committee. This multidisciplinary group meets monthly to discuss trends, barriers, metrics, education, and needs related to ED sepsis screening and alerts. The most successful educational committee activities provided were 3-hour sepsis classes for ED Registered Nurses and Paramedics during Spring 2015. Purpose was to increase ED awareness that sepsis kills without early recognition and intervention. Pathophysiology of sepsis, sepsis scoring tool, patient assessment, interventions, medications, case scenarios, and sepsis data were topics presented in these sessions. This education has now been integrated into orientation curriculum for all new staff.

Results:

One sepsis committee outcome was increased open communication channels between ED staff and physicians. Sepsis committee members give staff personalized feedback, ensuring staff understand urgency to act when patients are identified as sepsis alerts. Improved patient outcomes were evidenced by decreased: (1) median time to first fluid bolus administration from 65 minutes in 2014 to 32 minutes in July of 2017 and (2) median time to antibiotic administration from 137 minutes to 68 minutes (Fig. 1).

Conclusions/Implications:

Standardization of care using a sepsis scoring tool improves patient outcomes. The monthly sepsis meetings empower staff with knowledge, engage staff, and create accountability. Committee members are resources on the unit and help identify and recognize drifts from set benchmarks.

Fig. 1.

Annotated run chart from January 2014 to August 2017 of median time (hours and minutes) from triage to first fluid bolus and first antibiotic.