Jaworski, Stephen, MD

Palilonis, Matthew, DO

Yaeger, Susan K, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT Improving Pediatric Sepsis in the Emergency Department Using an Electronic Triage Tool Stephen Jaworski MD Matthew Palilonis DO Susan K. Yaeger MD Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, Pennsylvania• A pediatric sepsis workflow was associated with improvements in time from triage to antibiotics• Reduced variation and delays in care should lower associated healthcare costs from complications• Expansion to other EDs may reduce morbidity and mortality from pediatric sepsis Improving Pediatric Sepsis in the Emergency Department Using an Electronic Triage ToolREFERENCES• 80 of 3,888 pediatric ED encounters triggered the BPA• 150 of 4036 encounters met inclusion criteria based on diagnosis code– A convenience sample was used, and 33 were analyzed directly Pre-BPA (2019) Post-BPA (2020)Total n 33 80Age <60 days 13 (39.3%) 13 (16.2%)60 days - <1 year 13 (39.3%) 6 (7.5%)1 year – 4 years 5 (15.1%)) 33 (41.2%)5 years – 11 years 1 (0.30%) 20 (25%)12 years – 17 years 1 (0.30%) 8 (10%)Sex Male 21 (63.6%) 44 (55%)Female 12 (36.3%) 36 (45%)• Uncontrolled before and after study at a US pediatric ED • Pediatric sepsis workflow went live January 27th, 2020– Best Practice Advisory (BPA) fired by Electronic Medical Record (EMR) for abnormal vitals– Sepsis assessment performed by bedside clinician – New order set based on patient’s age • Data from 1st 60 days compared to same date range from 1 year prior– Compared patients who triggered BPA to patients with diagnoses likely to trigger BPAStephen Jaworski, Matthew Palilonis, DO, and Susan Yaeger, MD BackgroundMethodsResults DiscussionConclusions1. Mathias B, Mira JC, Larson SD. Pediatric sepsis. Current opinion in pediatrics. 2016;28(3):380-387.2. Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric severe sepsis*. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2013;14(7):686-693.3. Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Critical care medicine. 2014;42(11):2409-2417.4. Bradshaw C, Goodman I, Rosenberg R, Bandera C, Fierman A, Rudy B. Implementation of an Inpatient Pediatric Sepsis Identification Pathway. Pediatrics. 2016;137(3):e20144082.5. Lawal AK, Rotter T, Kinsman L, et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC medicine. 2016;14:35.6. Larsen GY, Brilli R, Macias CG, et al. Development of a Quality Improvement Learning Collaborative to Improve Pediatric Sepsis Outcomes. Pediatrics. 2021;147(1).7. Greenwald E, Olds E, Leonard J, Deakyne Davies SJ, Brant J, Scott HF. Pediatric Sepsis in Community Emergency Care Settings: Guideline Concordance and Outcomes. Pediatr Emerg Care. 2020.8. Scott HF, Deakyne SJ, Woods JM, Bajaj L. The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2015;22(4):381-389.9. Balamuth F, Alpern ER, Grundmeier RW, et al. Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2015;22(11):1298-1306.10. Depinet H, Paul R, Balamuth F, et al. Pediatric Septic Shock Collaborative: Description of Early Improvement. Pediatrics. 2018;142(1 MeetingAbstract):110-110.11. Balamuth F, Alpern ER, Abbadessa MK, et al. Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign-Based Electronic Alert and Bedside Clinician Identification. Annals of emergency medicine. 2017;70(6):759-768.e752.Problem Statement• Sepsis is the most common cause of pediatric deaths worldwide• $4.8 billion economic impact• Delays in treatment increase morbidity and mortality • SIRS vital signs have low sensitivity for critical illness• Physicians have higher specificity for identifying sepsis• Algorithmic alerts have high sensitivity for identifying sepsisThis project evaluates whether the implementation of a pediatric sepsis workflow including an electronic triage tool which identifies children at risk for sepsis, a clinician bedside evaluation, and a sepsis order set in a pediatric emergency department (ED) can reduce the time to antibiotics in pediatric patients with sepsis. • Significant improvements in time from triage to antibiotics were demonstrated (p=0.018)• Improvements in time from triage to IV fluids were not significant (p=0.307)• Baseline data regarding time to and from huddle is presented and may be useful for future process evaluation • Patient ages differ between compared populations• Use of diagnosis codes approximates BPA triggers, but is not direct comparison of patients who triggered a BPA Pre-BPA (minutes) Post-BPA (minutes)Triage to antibiotics 186 99Triage to IV fluids 118 73Triage to Huddle N/A 27Huddle to antibiotics N/A 81Huddle to IV fluids N/A 58Huddle to re-huddle N/A 61Last huddle to antibiotics N/A 72Last huddle to IV fluids N/A 49Figure 1: Diagram of Pre-BPA encounter inclusion and exclusionTable 1: Demographics of patients in visits included in pre-BPA and post-BPA analysis.Table 2: Average times for key performance indicators before and after implementation of the BPAPre-BPA Post-BPA Triage to antibiotics under 60 minutes 0% 41%Triage to IV fluids under 60 minutes 19% 45%Triage to huddle under 30 minutes N/A 78%Huddle to antibiotics under 60 minutes N/A 52%Huddle to IV fluids under 60 minutes N/A 65%Huddle to re-huddle under 60 minutes N/A 50%Last huddle to antibiotics under 60 minutes N/A 65%Last huddle to IV fluids under 60 minutes N/A 77%Table 3: Percentages of patients meeting criteria for key performance indicators before and after implementation of the BPA.

Improving Pediatric Sepsis in the Emergency Department Using an Electronic Triage Tool

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Improving Pediatric Sepsis in the Emergency Department Using an Electronic Triage Tool

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