2021 Annual Conference

CNS Improving Outcomes
CNS as Project Manager
Quality Initiatives
Patient Populations
Capture Value of the CNS
Interprofessional Collaboration

Title:  Improving door to antibiotic times for septic pediatric patients that present to the emergency department

Background: Sepsis remains a leading cause of pediatric mortality. Antibiotic administration within an hour of identification of sepsis and septic shock has shown to improve outcomes for pediatric patients.  Our children’s hospital implemented a sepsis screen for early recognition and treatment of patients at risk for sepsis in the emergency department. Abnormal vital signs, skin color, capillary refill, and history of high risk conditions trigger an alert prompting a huddle at the patient's bedside with the attending physician, charge nurse, and bedside nurse.  After the huddle, patients deemed high risk for sepsis are placed on a sepsis pathway, which is a combination of diagnostic tests and early goal-directed therapy. We found that our door to antibiotic administration within 60 minutes improved from 76 %to 93% after our implementation of a sepsis tool in the EHR and standardizing our response process. 

Methods:  After identifying our current state through a retrospective chart review of patients that should have received antibiotics within 60 minutes, the PDSA (plan, do, study, act) methodology was used for gap analysis that identified we did not have a standard process or outcome measures to achieve the 60-minute time goal of antibiotic administration for pediatric septic patients.  The following metrics were used for our sepsis improvement initiatives; identification of sepsis to antibiotics, time of identification of sepsis to ED team huddle, time for provider orders to be placed, time to IV established, and antibiotic order to antibiotic delivery time. 

Hypothesis:

1.      If we send out an ever bridge page as a huddle trigger, then we expect one process for sepsis awareness

2.      If we require physicians to enter orders within 15  minutes of receiving ever bridge page, then we expect orders to be placed within 15 minutes

3.      If we create an infographic of the ED sepsis process inclusive of times for staff on a weekly basis, then we expect everyone to have a shared understanding of expectations related to improving door to antibiotic times

4.      If we create a process around sepsis IV starts, then we expect an IV to be placed within 30 minutes or IM antibiotics to be administered

Results:

Number of patients put on the sepsis pathway: 70

Percent of patients that received a sepsis huddle: 87.14%

Medium time of huddle from sepsis alert: 00:02

Medium time to antibiotic order: 00:01

Percent of antibiotics given in less than 60 minutes: 93.85%

Conclusion: Identification and team-based decision support through the use of an EHR screening tool and standardized treatment interventions are important for improving door to antibiotic times within 60 minutes for septic pediatric patients in the emergency department. Future research would look at cost savings and decreased length of stay for patients that received antibiotics within an hour compared to those who did not.