Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the Implementation of a Pediatric Sepsis Pathway Within the Emergency Department

Amanda Harley; Paula Lister; Patricia Gilholm; Michael Rice; Bala Venkatesh; Amy N B Johnston; Debbie Massey; Adam Irwin; Kristen Gibbons; Luregn J Schlapbach

doi:10.1097/CCE.0000000000000573

Queensland Pediatric Sepsis Breakthrough Collaborative: Multicenter Observational Study to Evaluate the Implementation of a Pediatric Sepsis Pathway Within the Emergency Department

Crit Care Explor. 2021 Nov 8;3(11):e0573. doi: 10.1097/CCE.0000000000000573. eCollection 2021 Nov.

Authors

Amanda Harley^{1

2

3

4}, Paula Lister^{2

5

6}, Patricia Gilholm², Michael Rice⁷, Bala Venkatesh^{8

9

10}, Amy N B Johnston^{1

11}, Debbie Massey¹², Adam Irwin^{13

14}, Kristen Gibbons², Luregn J Schlapbach^{2

15}

Affiliations

¹ School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Qld, Australia.
² Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.
³ Critical Care Nursing Management Team, Queensland Children`s Hospital, Brisbane, Qld, Australia.
⁴ Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Qld, Australia.
⁵ Pediatric Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia.
⁶ School of Medicine, Griffith University, Brisbane, Qld, Australia.
⁷ Clinical Excellence Queensland, Queensland Health, Brisbane, Qld, Australia.
⁸ The George Institute for Global Health, Sydney, NSW, Australia.
⁹ Department of Intensive Care Medicine, Wesley Hospital, Brisbane, Qld, Australia.
¹⁰ University of Queensland, Brisbane, Qld, Australia.
¹¹ Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Qld, Australia.
¹² School of Nursing and Midwifery, Southern Cross University, Gold Coast, Qld, Australia.
¹³ UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia.
¹⁴ Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Qld, Australia.
¹⁵ Pediatric and Neonatal Intensive Care Unit, and Children`s Research Center, University Children's Hospital Zurich, Zurich, Switzerland.

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.

Keywords: child; critical care; management; pathway; recognition; septic shock.