Children's Hospitals Today - Summer 2016 - 20
TAKING ACTION
Working together
to save lives
In June, children's hospitals
participating in the Improving Pediatric
Sepsis Outcomes collaborative began
mobilizing to target improvement
across all levels of care. The goal is
to reduce sepsis deaths and hospitalonset severe sepsis by 75 percent. "This
will accelerate discovery and evidence
around whether something works by
having pools of organizations involved,"
says Charles Macias, M.D., MPH, chief
clinical systems integration officer,
Texas Children's Hospital, and national
co-chair of the collaborative. "It's about
standardization and best practices."
According to Toni Wakefield, M.D.,
pediatric hospitalist at Dell Children's
Hospital, one institution by itself won't
see the volume of sepsis patients to
know which way of screening is better.
"If we can come up with a combination
of markers and vital signs that have
good sensitivity and specificity-that
would be the Holy Grail. And we're only
going to get that if we collaborate."
While information and best practices
will be shared among all children's
hospitals and the industry at large
during key milestones, participating
hospitals will have access to:
Bundles and feasible measures
based on the best evidence
A data infrastructure to customize
and simplify submission and
performance tracking
Virtual learning, interaction
activities and workshops
Training, tools and resources
Hospitals may still sign on to
participate. Visit childrenshospitals.org/
sepsiscollaborative for more information.
20
CHILDREN'S HOSPITAL S TODAY Summer 2016
EMR data back that up, that person is
more comfortable and confident about
raising a red flag for possible sepsis.
"It empowers nurses, physicians and
respiratory care practitioners to say, 'I
need to act on this, because it's not just
me,'" Macias says. "Here's a medical
calculation showing this person is at risk.
And, that has changed our culture."
That culture change has also led to a
change in outcomes at Texas Children's.
These changes include a 50 percent
decrease in the amount of time it takes
to get from the first diagnosis to the
administration of antibiotics, and a 9
percent decrease in PICU-related sepsis
mortality in the last five years. "In the
end, we can look at process measures, but
what is most compelling is the number of
lives we save," Macias says.
The adult dilemma
When it comes to sepsis, the definitions,
data and guidelines for care all hail from
the adult world, which only further
complicates sepsis care in pediatrics.
"Children are different, so the adult
work is not going to be applicable as is,"
Wakefield says. "It needs modification
for a child's physiology." UNC Hospitals
in Chapel Hill, N.C. is not only taking
that into account, but it's operating in
an inverted universe-where pediatric
sepsis care at UNC Children's Hospital
helps inform care on the adult side
of the system.
As one example, pediatrics is used to
giving fluid resuscitations to children
with sepsis in a weight-based bundle,
taking the child's physiology into account.
However, emergency room or inpatient
nurses for adults are accustomed to
giving a set number of liters per patient,
according to Tina Schade Willis, M.D.,
associate chief medical officer for quality
at UNC Hospitals, which includes UNC
Children's Hospital. "Our pediatric nurses
have been able to help the adult side with
how to think about measuring fluid in a
weight-based way," Schade Willis says.
"We try to collaborate as much as we can
to help each other."
Code Sepsis
UNC Children's Hospital also served as
the June 2015 launching ground for the
system's new Code Sepsis program before
taking it live with adults. Just like with
a Code Blue, any staff member or nurse
can pick up the phone and use the same
number they would to call a code. "They
can say, 'I have a Code Sepsis in Room
X,'" Schade Willis says. "That will activate
our pediatric or adult rapid response
team, depending on whether it's an adult
or pediatric patient." When the rapid
response team arrives, they understand
this is likely a sepsis patient and are ready
to use the sepsis bundle, she says. There's
also a Code Sepsis pharmacist for adults
and for pediatrics who is notified to speed
time to administer antibiotics.
In the PICU, an "informal" Code Sepsis
approach-a direct outreach to the
most senior ICU physician versus calling
the operator-requires that physician
to assess the patient at the bedside
immediately. If the patient is deemed
septic, they go through the formal Code
Sepsis pathway. "The lesson learned was,
if you use that phrase, even if you're not
calling through a formal system, it puts
everyone in the mindset you actually
have to get this done quickly, and it
requires a team coming together," Schade
Willis says. "Just like a trauma or any
other code scenario."
This team-based approach has reduced
the time it takes to get blood cultures and
administer antibiotics and the first fluid
resuscitation from several hours down
to, in some cases, 10 minutes. The key to
the team's success, Schade Willis says, is
incorporating sepsis in routine emergency
measures training and holding ongoing
large-scale sepsis simulations. "Simple
low-fidelity, hands-on practice has been
the most important thing beyond an
childrenshospital s.org
http://www.childrenshospitals.org/sepsiscollaborative
http://www.childrenshospitals.org/sepsiscollaborative
http://www.childrenshospitals.org
Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2016
Contents
Children's Hospitals Today - Summer 2016 - Cover1
Children's Hospitals Today - Summer 2016 - Cover2
Children's Hospitals Today - Summer 2016 - Contents
Children's Hospitals Today - Summer 2016 - 2
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