Emergency medicine Australasia : EMA · 2025
Impact of an evidence-based sepsis pathway on paediatric hospital clinical practice: A quality improvement study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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McCarthy Bernard, Middleton Natalie, Gill Fenella J, Goff Zoy, Paterson Zoe, Blyth Christopher C, CAHS Sepsis Working Group
Аннотация
OBJECTIVES: To assess the impact of implementing a sepsis pathway and education program on key sepsis outcomes and performance targets in a tertiary paediatric hospital.
METHODS: A quality improvement study using a multi-modal screening process and pragmatic clinical definitions. Treatment of all children with septic shock and sepsis without shock 4 months prior to pathway/education package launch was compared with those meeting definitions 8 months post-launch.
RESULTS: Over the study period, 1483 episodes were screened; 517 episodes met study definitions (171 pre-launch; 346 post-launch). Eighty-two episodes met septic shock definitions (15.9%) and 435 met sepsis without shock definitions (84.1%). A total of 143 episodes pre-launch and 271 episodes post-launch were managed exclusively at Perth Children's Hospital (PCH). Post intervention, the pathway form was utilised in 146 of 271 episodes (53.9%). Pathway/education package introduction was associated with a reduction in the median time from recognition to antibiotic administration (60 [IQR: 26; 115] to 45 min [IQR: 16; 75] for those with septic shock and/or sepsis without shock treated exclusively at PCH; P < 0.001). The proportion receiving antibiotic therapy within recommended timeframes significantly increased (septic shock within 60 min: 70.0% to 92.5%, P < 0.03; sepsis without shock within 180 min; 86.2% to 94.8%, P = 0.005). No statistically significant change in length of stay, intensive care admission, mortality or antibiotic consumption was observed following pathway launch.
CONCLUSIONS: Paediatric sepsis pathway and education package implementation can reduce time to antibiotics in sepsis and aid local data collection and surveillance of patients treated for sepsis.
METHODS: A quality improvement study using a multi-modal screening process and pragmatic clinical definitions. Treatment of all children with septic shock and sepsis without shock 4 months prior to pathway/education package launch was compared with those meeting definitions 8 months post-launch.
RESULTS: Over the study period, 1483 episodes were screened; 517 episodes met study definitions (171 pre-launch; 346 post-launch). Eighty-two episodes met septic shock definitions (15.9%) and 435 met sepsis without shock definitions (84.1%). A total of 143 episodes pre-launch and 271 episodes post-launch were managed exclusively at Perth Children's Hospital (PCH). Post intervention, the pathway form was utilised in 146 of 271 episodes (53.9%). Pathway/education package introduction was associated with a reduction in the median time from recognition to antibiotic administration (60 [IQR: 26; 115] to 45 min [IQR: 16; 75] for those with septic shock and/or sepsis without shock treated exclusively at PCH; P < 0.001). The proportion receiving antibiotic therapy within recommended timeframes significantly increased (septic shock within 60 min: 70.0% to 92.5%, P < 0.03; sepsis without shock within 180 min; 86.2% to 94.8%, P = 0.005). No statistically significant change in length of stay, intensive care admission, mortality or antibiotic consumption was observed following pathway launch.
CONCLUSIONS: Paediatric sepsis pathway and education package implementation can reduce time to antibiotics in sepsis and aid local data collection and surveillance of patients treated for sepsis.