Bundled Care to Reduce Sepsis Mortality: The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative

Author:

Paul Raina1,Niedner Matthew2,Riggs Ruth3,Richardson Troy3,DeSouza Heidi Gruhler3,Auletta Jeffery J.4,Balamuth Frances5,Campbell Deborah6,Depinet Holly7,Hueschen Leslie8,Huskins W. Charles9,Kandil Sarah B.10,Larsen Gitte11,Mack Elizabeth H.12,Priebe Gregory P.13,Rutman Lori E.14,Schafer Melissa15,Scott Halden16,Silver Pete17,Stalets Erika L.7,Wathen Beth A.18,Macias Charles G.19,Brilli Richard J.20,

Affiliation:

1. aDivision of Emergency Medicine, Children’s Hospital of Orange County, University of California Irvine, Orange California

2. bUnaffiliated

3. cChildren’s Hospital Association, Lenexa, Kansas

4. dNationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio

5. eDepartment of Pediatrics, University of Pennsylvania, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

6. fKentucky Hospital Association, Louisville, Kentucky

7. gDepartments of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

8. hUniversity of Missouri-Kansas City, Children’s Mercy Hospital, Kansas City, Missouri

9. iMayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota

10. jDepartment of Pediatrics, Yale University School of Medicine, Yale New Haven Children’s Hospital, New Haven, Connecticut

11. kPrimary Children’s Hospital, University of Utah, Salt Lake City, Utah

12. lMedical University of South Carolina Children’s Health, Charleston, South Carolina

13. mDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Department of Anesthesia, Harvard Medical School, Boston, Massachusetts

14. nUniversity of Washington, Seattle Children’s Hospital, Seattle, Washington

15. oState University of New York Upstate Medical Center, Syracuse, New York

16. pDepartment of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Denver, Colorado

17. qCohen Children’s Medical Center of New York, Queens, New York

18. rChildren’s Hospital Colorado, Denver, Colorado

19. sDivision of Pediatric Emergency Medicine, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio

20. tNationwide Children’s Hospital, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbus, Ohio

Abstract

OBJECTIVES We sought to improve utilization of a sepsis care bundle and decrease 3- and 30- day sepsis-attributable mortality, as well as determine which care elements of a sepsis bundle are associated with improved outcomes. METHODS Children’s Hospital Association formed a QI collaborative to Improve Pediatric Sepsis Outcomes (IPSO) (January 2017–March 2020 analyzed here). IPSO Suspected Sepsis (ISS) patients were those without organ dysfunction where the provider “intended to treat” sepsis. IPSO Critical Sepsis (ICS) patients approximated those with septic shock. Process (bundle adherence), outcome (mortality), and balancing measures were quantified over time using statistical process control. An original bundle (recognition method, fluid bolus < 20 min, antibiotics < 60 min) was retrospectively compared with varying bundle time-points, including a modified evidence-based care bundle, (recognition method, fluid bolus < 60 min, antibiotics < 180 min). We compared outcomes using Pearson χ-square and Kruskal Wallis tests and adjusted analysis. RESULTS Reported are 24 518 ISS and 12 821 ICS cases from 40 children’s hospitals (January 2017–March 2020). Modified bundle compliance demonstrated special cause variation (40.1% to 45.8% in ISS; 52.3% to 57.4% in ICS). The ISS cohort’s 30-day, sepsis-attributable mortality dropped from 1.4% to 0.9%, a 35.7% relative reduction over time (P < .001). In the ICS cohort, compliance with the original bundle was not associated with a decrease in 30-day sepsis-attributable mortality, whereas compliance with the modified bundle decreased mortality from 4.75% to 2.4% (P < .01). CONCLUSIONS Timely treatment of pediatric sepsis is associated with reduced mortality. A time-liberalized care bundle was associated with greater mortality reductions.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Cited by 5 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3