A Multidisciplinary Kaizen Event to Improve Sepsis Response at an Academic Children’s Hospital

Background:

Since 2015, the Ann & Robert H. Lurie Children’s Hospital Emergency Department has engaged in efforts to prevent, recognize, and treat pediatric severe sepsis and septic shock. A dual-care pathway and order bundles have improved time to fluid resuscitation and antibiotic administration; however, we have not yet achieved the Surviving Sepsis Campaign timeliness goals.

Objectives:

Critically appraise clinical workflows across disciplines to improve timely fluid resuscitation, antibiotic administration, and pathway adherence in the emergency department.

Methods:

A core planning team organized a rapid improvement event, or Kaizen, informed by staff surveys assessing gaps and variations in established sepsis processes. Using a team-based approach, frontline providers mapped current workflows, identifying barriers and opportunities to improve care. A gap impact analysis was completed and solutions were prioritized by a PICK chart exercise.

Results:

Thirty-seven staff members across 17 disciplines participated. Gaps in workflows, communication, and resources emerged. Prominent communication gaps were evident between nurses and physicians on patient presentation and pathway selection. Delays in treatment were attributed to inaccessibility of supplies, inadequate task delegation, and a lack of urgency for yellow pathway patients. Prioritized interventions included scripted communication tools, a delineated response plan, and standardized reassessment processes. Revisions to the key driver diagram will guide future plan–do–study–act cycles.

Conclusions/Implications:

Dedicating time for frontline providers to participate in the improvement process uncovers barriers to care that would otherwise go unnoticed. Frontline engagement in a candid context is crucial to driving improvement by identifying root causes of ineffective processes and opportunities to optimize efforts.

Disclosure

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.