Halden Scott, MD, MS
Associate Professor of Pediatrics
University of Colorado School of Medicine
Aurora
Disclosure information not submitted.
Allison Kempe, MD, MPH
Professor of Pediatrics
Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, United States
Disclosure information not submitted.
Lalit Bajaj, MD, MPH
Professor of Pediatric Emergency Medicine
University of Colorado, United States
Disclosure information not submitted.
Daniel Lindberg, MD
Associate Professor of Emergency Medicine
University of Colorado, United States
Disclosure information not submitted.
Ashley Dafoe, MA
Qualitative Professional Research Assistant
Adult and Child Consortium for Health Outcomes Research and Delivery Science, United States
Disclosure information not submitted.
Brooke Dorsey Holliman, PhD, MA
Assistant Professor of Family Medicine
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, United States
Disclosure information not submitted.
Title: Motivations, Metrics, Misgivings: Pediatric Sepsis Care Quality in General (Nonchildren's) Hospitals
Introduction: Most septic children first receive care in general hospitals (which treat adults and children), while research and QI have focused on care at children’s hospitals. This study aimed to identify motivators and needs in managing pediatric sepsis in general hospitals, from the perspective of clinical leaders in these settings.
Methods: We conducted semi-structured interviews with physician and nurse leaders (medical directors, nurse managers, quality coordinators) in general hospitals in a multi-state US region. Interviews were conducted via Zoom, audio recorded, and transcribed verbatim. Transcripts were coded in Atlas.ti (v.9). Qualitative matrix analysis was used to analyze across interviews by deductive domains.
Results: We conducted 19 interviews with key informants, representing 28 hospitals. Rural, urban, and Trauma Levels 1-4 were included. The following themes were identified (with representative quotes).
1. Location is motivation. Hospitals geographically far from a children’s hospital prioritized pediatric sepsis preparedness. A sense of community was motivating. “These are our kids, our friends’ kids, you’re gonna see ‘em.”
2. Children’s hospitals’ role. Many relied on their regional children’s hospital for sepsis algorithms, education, transfer and real-time phone consultation. “…a close partnership with our Children’s Hospital. We’ve never really done our sepsis programming alone.”
3. Current pediatric sepsis guidelines and definitions lack specificity. “We did… review the new pediatric sepsis guidelines, and I felt like the biggest problem with those is that they were very non-descriptive. All of them were like, maybe do this, but maybe also consider this.”
4. Mandates and metrics are “a double-edge sword.” Some thought legislative mandates would increase local resources/support for pediatric sepsis; others worried about interpreting metrics where pediatric cases were rare. “Those mandates would be nice to give us guidance, but at the same time, how do we adapt that to a rural hospital?”
Conclusion: General hospitals were motivated to provide high-quality pediatric care. They would like more specific pediatric sepsis guidelines, and regional children’s hospitals' support. These findings can guide pediatric leaders seeking to support general hospitals and pediatric sepsis preparedness.