George Nassar, MD
Pediatric Resident
NYU Winthrop Hospital
Mineola, NY
Disclosure information not submitted.
Danielle Wolfe, M.D.
Dr. Danielle Wolfe
NYU Langone-Long Island Hospital, United States
Disclosure information not submitted.
Maria Lyn Quintos-Alagheband, M.D.
Dr. Lyn Quintos
NYU Langone-Long Island Hospital, United States
Disclosure information not submitted.
Title: Improving Care for Pediatric Sepsis through Resident Engagement in Performance Reviews and Education
Introduction: Sepsis and septic shock affect millions of people worldwide, resulting in death in 1 of 4 of those affected. Globally there are 49 million cases of childhood sepsis per year with 11 million deaths/year. In the U.S. pediatric sepsis accounts for 75,000 hospitalizations/year with 6,800 deaths/year and annual cost of pediatric sepsis is estimated at 4.8 billion dollars/year. Early identification and goal-directed therapy, via pediatric sepsis bundle compliance, is important to increase survival rates and improve patient outcomes and readmission rates. Monthly quality improvement review of pediatric sepsis cases showed an opportunity for improvement in resident knowledge on best practice advisory alerts (BPA alerts), sepsis recognition and goal-directed management.
Methods: 1st-2nd Q 2020: Resident engagement in monthly reviews of pediatric sepsis cases.
3rd and 4th Q 2020: Sepsis case-based discussion integrated into resident monthly safety rounds by the quality improvement officer.
1st Q 2021: Standardized resident sepsis education. Resident-driven best practice advisory review with direct feedback.
2nd Q 2021: 'Just in Time' education implemented during pediatric resident's inpatient rotations. Collection of Resident pre-and post-test data prior to and following monthly case reviews.
Results: Through the implementation of monthly sepsis case reviews, resident safety rounds, and resident education, compliance to the one-hour sepsis maintenance bundle increased from a baseline of 68.8% in 2019 to 88.9% in 2020. Implementation of monthly resident ‘Just in Time’ education, as measured by pre-and post-test questionaries, showed an improvement of ~26% in resident knowledge.
Conclusion: Engaging residents in sepsis process improvement is a critical driver in achieving effective and efficient care for pediatric sepsis. Through the implementation of monthly sepsis case reviews, resident safety rounds, and resident education, compliance to the one-hour sepsis maintenance bundle increased from a baseline of 68.8% in 2019 to 88.9% in 2020. This is a 30% improvement in process reliability to the one-hour pediatric sepsis bundle, exceeding our goal. Our goal for 2021-2022 is to achieve and maintain sepsis bundle compliance of >90% with continuous quality improvement.