Berks County Medical Society Medical Record Fall 2019 - 31

Use of Electronic Medical
Record-Based Alert and Sepsis
Pathway to Improve Quality
of Pediatric Sepsis Care in the
Emergency Department
by Henry Smychynsky, Pennsylvania State University;
Christopher Valente, MD
INTRODUCTION: An automated sepsis screening pathway has
been implemented at Reading Hospital with hopes of streamlining
pediatric sepsis treatment. Our hypothesis states that the screening
pathway will have a statistically significant impact on lowering times
to both antibiotic and fluids for pediatric patients being treated for
sepsis.
METHODS: During a one-year period, all pediatric patients
(younger than eighteen years and older than twenty-eight days)
at Reading Hospital who were intently and specifically treated
for sepsis were included in this study. Patients that were treated
for sepsis prior to the implementation of the pathway (March
13th) were placed in one group as the control. The second group
consisted of pediatric sepsis patients that were treated after the
implementation of the pathway. The elapsed time for administration
of both a fluid bolus and antibiotics was calculated for each patient.
Mean and median times for fluids and antibiotics were then
calculated for both groups, and comparisons were made based on the
magnitudes of elapsed time.
RESULTS: Twenty-seven patients were enrolled in the pre-pathway
group of the study. The average elapsed times to antibiotics and
fluids for pre-pathway patients were 169.7 and 96 minutes,
respectively. On March 13th, the sepsis pathway was implemented
at the hospital. From March 13th to May 31st, 1,541 out of 6,160
total patients (25%) triggered the first alert of the pathway. Of
them, 183 patients triggered the second alert, which is 11.9% of
the first alert patients and 3% of the total patient volume. 161 total
sepsis huddles were documented, with 17 (10.6%) progressing to
suspect sepsis and pathway initiation. From those final 17 patients,
7 patients (0.1% of total patient volume) qualified to be placed in
the post-pathway group of the study. For post-pathway patients,
values were notably lower with average elapsed times for antibiotics
and fluids being 124.5 and 85.7 minutes, respectively. Additionally,
median values were calculated to analyze the data in the absence of
outliers. The median elapsed times for pre-pathway patients were 74
minutes for fluids and 125 minutes for antibiotics. For post-pathway
patients, the median elapsed times were significantly lower at 39
minutes for fluids and 99 minutes for antibiotics.

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CONCLUSION: The implementation of the sepsis screening
pathway has a clinically significant impact on lowering times
to both antibiotics and fluids for pediatric sepsis patients. With
prolonged research in the coming months, this study would
achieve statistical significance.
Henry Smychynsky is in his final year as a pre-med student
at Penn State, University Park. In 2014-2016 he was
Chair of the Mini-THON at Wyomissing Area High School.
Also while at Wyomissing he served as a math tutor and
participated in the Big Spartan/Little Spartan program.
continued on next page

FALL 2019

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Berks County Medical Society Medical Record Fall 2019

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