Michael Grassi, MD
Resident Physician
University of Arkansas for Medical Sciences, Arkansas, United States
Disclosure information not submitted.
Sanjiv Pasala, MD, FAAP
Associate Professor
University of Arkansas for Medical Sciences, Arkansas, United States
Disclosure information not submitted.
Blair Langston, BSN
Educator, Pediatric Intensive Care Unit
Arkansas Children's Hospital, Arkansas, United States
Disclosure information not submitted.
Michael Stroud, MD
Associate Professor of Pediatrics
University of Arkansas for Medical Sciences Arkansas Childrens Hospital, United States
Disclosure information not submitted.
Title: A Stepwise Approach to Improve Recognition and Resuscitation of Septic Shock in the PICU
Introduction: Sepsis is a major health issue in pediatrics. 80,000 children are admitted to hospitals yearly, with an estimated 5,000 deaths. Early recognition and resuscitation improve outcomes. As part of the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes Collaborative we embarked on a quality improvement (QI) initiative in the PICU to improve care delivery for septic shock. We hypothesized that a stepwise approach to improve recognition and resuscitation of children with septic shock would improve clinical outcomes.
Methods: A critical sepsis screening tool was constructed to identify PICU patients at risk for septic shock and sepsis-associated organ dysfunction. The screening tool is completed on each patient every shift and triggered by the Electronic Medical Record (EMR). Following EMR activation a huddle is commenced with key team members to determine clinical status and need for resuscitation. Two SMART goals have been completed: commencement of huddle with EMR activation and >90% presence of PICU attending at huddle. Future SMART goals are timely administration of antibiotics and time to IV fluid boluses.
Results: Since Feb 2020, 5,874 PICU patients have been screened. EMR activation occurred 1,784 times, leading to 344 bedside huddles. 207 (11.6%) met clinical screening criteria (18.4% altered mental status, 62.8% delayed capillary refill, 31.9% hypotension, 23.7% elevated lactate). 194 (10.9%) met laboratory screening criteria (66.5% abnormal WBC, 40.7% decreased urine output, 57.7% platelets < 100K, 6.2% metabolic acidosis, 19.6% elevated procalcitonin, 13.4% elevated creatinine). Following the 344 bedside huddles, resuscitation occurred in 21.6% (33.7% fluid boluses, 26.2% new antibiotics, 56.7% new cultures, 57.8% new labs). A diagnosis of septic shock or sepsis-associated organ dysfunction was entered into the EMR in 39.8%. Bedside huddles occurred in 100% of EMR activations. Attending presence improved from 82% to >95%.
Conclusions: Septic shock and sepsis-associated organ dysfunction continue to be major pediatric health issues. Early recognition and resuscitation are key to improving outcomes. A stepwise approach to improved recognition and resuscitation in the PICU has the potential to improve care delivery for children with septic shock and sepsis-associated organ dysfunction.