Children's Hospitals Today - Winter 2023 - 5

COMMENTARY / ROUNDS
Simple tech saves
Low-cost technological interventions can cut sepsis mortalities in half.
BY SARAH KANDIL and VICTORIA HABET
S
epsis remains a leading cause of pediatric morbidity and
mortality, hospitalizing 40,000 children in the U.S. and
killing 5,000 annually. The condition is treatable when recognized
early, but it can encompass a broad range of underlying
causes and present in different ways, making it difficult to
identify. Common indicators of sepsis, such as fever and
tachycardia, are prevalent in children without sepsis, and
vital sign changes may not be reliable markers for sepsis in
medically complex patients.
These factors make sepsis easy to miss, but technology can
reduce the risk by creating a shared mental model of potential
sepsis, monitoring specific risk factors, and alerting frontline
workers. This can be done with an automatic system that reliably
screens patients at regular intervals within the electronic
health record (EHR). Yale New Haven Children's Hospital in
New Haven, Connecticut, uses an electronic screening tool
based on age-adjusted vital signs as well as clinical markers
of perfusion. The tool is integrated with the hospital's EHR to
access a broad range of clinical information to identify rapid
changes in the physiologic status of hospitalized children,
providing increased opportunities for earlier intervention.
When a patient screens positive for potential sepsis, a best
practice alert (BPA) appears in the patient's chart,
which includes sepsis pathways and standardized
order sets. The team also uses the EHR software to
perform a case-by-case review to reveal missed
cases and perform a root cause analysis to adjust
the measurements for sepsis indicators.
Over a two-year period (2017-2019), the rate of
Importantly, it takes time for evidence-based medicine and
MORTALITY
hospital-onset severe sepsis at Yale New Haven
Children's Hospital decreased from a baseline
rate of 2.05% to 0.38% following the implementation
of the screening trigger tool, as well as
other initiatives such as an order set, dashboard,
sepsis simulation, and education. Mortality related to sepsis
decreased from 16% to 5% over two years, and median length
of stay decreased from 18 to 11 hospital days.
Though implementing these interventions is simple, there
RELATED TO SEPSIS
DECREASED FROM
16% TO 5% OVER
TWO YEARS.
new practice guidelines to be integrated and adopted into
current clinical practice-research suggests that it can take
up to 20 years. The Surviving Sepsis Guidelines are updated
every few years, which means hospitals must be
agile to incorporate the recommendations as the
standard of care at all levels of patient care.
While technology cannot replace the physical
exam skills and critical thinking of frontline providers,
it can serve as an invaluable tool to improve
early recognition of sepsis. Of course, continued
education will be critical to optimize the use of the
technology as it continues to evolve.
Despite these challenges, our single-center experience
demonstrates that low-cost technological
interventions can successfully reduce the rate of
hospital-onset severe sepsis without increasing lengths of stay
or intensive care admissions at children's hospitals.
are some challenges. There must be buy-in from the frontline
teams using the electronic interface who already experience a
high burden of alarms. To minimize alarm fatigue, it is crucial
to regularly evaluate the screening trigger tool and validate
the model in pediatrics.
Sarah Kandil, M.D., is Deputy Quality and Safety officer, director
of Sedation Services, and pediatric intensivist, Yale New Haven
Children's Hospital. Victoria Habet, D.O., is Senior Clinical Fellow
in Cardiac Intensive Care, Boston Children's Hospital.
Tell your hospital's story. Email magazine@childrenshospitals.org.
CHILDREN'S HOSPITALS TODAY Winter 2023
5
Children's Hospitals Today - Winter 2023

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