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Quality improvement program decreases septic shock mortality
A quality improvement initiative resulted in decreased mortality in pediatric septic shock patients without increasing ICU admissions or ED lengths of stay, according to study findings published in Pediatrics.
“An analysis revealed inconsistency among providers regarding fluid administration strategies, antibiotic selection and timing, and laboratory evaluation,” Roni D. Lane, MD, associate professor of pediatrics at the University of Utah, and colleagues wrote. “Compliance with and awareness of pediatric septic shock national guidelines and recommendations were low among [pediatric ED (PED)] personnel.”
Lane and colleagues implemented several [quality improvement (QI)] interventions in a 7-year period at Primary Care Children’s Hospital in Utah to examine changes in clinical practice, longitudinal effectiveness of the initiative and outcomes associated with the program. From February 2007 to December 2014, 1,380 children (median age, 3.8 years) were treated for septic shock, and 93% met screening criteria during triage. The researchers assessed patient compliance and outcomes from reactions to bundled care (antibiotics and IV fluids for rapid reversal of perfusion abnormalities and hypotension).
Logistic regression model showed that QI resulted in better overall patient care. In the cohort, 24 patients (1.7%) died, and days between patient deaths increased during the last 2 years of the study. Children who did not receive bundle-compliant care were at a fivefold increased risk for death (OR = 5; 95% CI, 1.9-14.3) vs. those who did (OR = 0.2; 95% CI, 0.07-0.53). Children admitted to the PICU with abnormal mental status and a higher pediatric index of mortality 2 score were at increased risk for death. In addition, PICU admission correlated with decreased PED costs.
“Sustainability is achieved through multiple key drivers including an engaged, dedicated team with consistent personnel structure, use of QI tools to monitor progress, and provision of specific, timely positive feedback and solicited concerns from front-line caregivers,” the researchers wrote. “The next steps include addressing timely recognition and treatment of sepsis across the spectrum of care, particularly within intensive care, inpatient and hematology/oncology units, as well as adult ED where children are evaluated.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
