Uchechi Oddiri, MD, FAAP
Clinical Assistant Professor of Pediatrics
Stony Brook Univ. School of Medicine
Stony Brook, NY
Disclosure information not submitted.
Grace Propper, MS, RN, CPNP, NNP-BC, CPHQ
Associate Director, Quality Management Division
Stony Brook University Hospital, United States
Disclosure information not submitted.
Patricia Brill, MSN, RN, C, NNP
Quality Management Practitioner, Quality Improvement Department
Stony Brook University Hospital, United States
Disclosure information not submitted.
Brienna Reid, MSN, RN
Information Technology
Stony Brook University Hospital, United States
Disclosure information not submitted.
Carolyn Milana, MD
Associate Professor of Clinical Pediatrics, Department Chair
Stony Brook University School of Medicine, United States
Disclosure information not submitted.
Title: Early Identification of Severe Sepsis in Pediatric Patients Utilizing an Electronic Alert
Introduction: Sepsis left untreated can lead to severe sepsis, septic shock, and death. For patients who escalate to severe sepsis, prompt recognition and timely initiation of standardized treatment bundles leads to improved outcomes. We sought to develop a unique real-time automated severe sepsis alert to notify physicians directly via the electronic medical record (EMR) and the paging system. Our goal was to identify and rapidly treat pediatric patients with severe sepsis in our ED and inpatient units. Our SMART AIM was to reduce mortality due to sepsis by improving one-hour bundle compliance by 30% within 2 years of implementing the electronic severe sepsis interruptive alert.
Methods: Criteria for the alert were developed by our interdisciplinary team and were based on the 2005 International Pediatric Consensus definitions. If SIRS criteria were met with organ dysfunction based upon vital signs and lab results in the EMR, an interruptive alert will appear upon opening that patient’s chart and a notification page will be sent to an attending physician, who evaluates the patient and initiates treatment as warranted. Response to alert and documentation is required. Prior to alert roll-out, educational sessions were conducted. Accuracy of alert fires, physician compliance with answering alert, event documentation, and bundle compliance were monitored. PDCA cycles were performed along with ongoing education.
Results: Baseline data on completion of all bundle elements (one hour to obtain blood cultures, initiate antibiotics and fluids) for 2016 and 2017 were 23% and 50% respectively. Our electronic alert went live in 2018. Bundle compliance rose to 65% in 2019 then to 71% in 2020. Our sepsis mortality rates have dropped to a mean rate of 8% over the last three years, a rate significantly lower than the Vizient top 20 pediatric hospitals rate of 11.7%.
Conclusion: An automated, interruptive severe sepsis screening alert sent directly to providers is a valuable tool to ensure prompt severe sepsis recognition and treatment, decreasing sepsis mortality. We attribute this success to prompt recognition leading to earlier initiation of treatment. Additionally, we appreciated improved communication between all team members. Future directions include developing a tool applicable to the neonatal ICU and the newborn nursery.