1452 Sustainability is far more important than one successful audit cycle. Our experience after introducing a new sepsis triage tool to our emergency department

Abstract

<h3>Background</h3> Implementing change and ensuring sustainability could be challenging in the complexity of multifactorial heath care system. One successful audit cycle is not enough. <h3>Objectives</h3> To ensure the sustainability of successfully introducing the Wessex sepsis triage tool in our Paediatric Emergency Department (ED). The patients triggering the tool require a senior review within 15mins of escalation and if sepsis was suspected by the clinician, the IV-antibiotics need to be given within 1 hour from time of decision. <h3>Methods</h3> Regular PDSA cycles were undertaken with results shared and discussed across the disciplines. There was early and frequent involvement and feedback from the multidisciplinary staff, including regular focus groups and small group education sessions. These provided a forum to allow discussions and subsequent changes to the tool by the users themselves. Regular audits, looking at key quality indicators, were undertaken to review compliance. <h3>Results</h3> We undertook 5 PDSA cycles between 2018 and 2020, looking at snapshot data of 3–5 days. This demonstrated a continued increase in the uptake of the tool. Prior to introducing this tool, only 33% of the total number of children who would have triggered for suspected sepsis were being identified at triage. Post introduction, this improved to 46% of children being appropriately escalated with the tool and further audits showed a sustainable improvement to 60% use. However, we observed in our most recent cycle that there was a deterioration in the timing of the senior review (from average 2hours 17minutes to 3hours 47minute) and time of the antibiotics given (from average 1hour 13minutes to 2hours 20minutes). We suspect a recent period of considerable staff turnover may have partially contributed to this. The most recent focus group discussion showed 90% of the group were positive about the recent sepsis tool (version 5); it is easy to follow, user- friendly and gives precise guidance. Nursing team felt more empowered to escalate care when indicated and to approach a senior clinician when needed. Analysis of feedback acknowledged the request for training in rapid assessment and triage (RAT), particularly for non-ED staff, and the need for regular awareness and teaching for the high turnover of staff. <h3>Conclusions</h3> By engaging our stakeholders and multidisciplinary staff, seeking frequent constructive feedback and performing regular PSDA cycles, we ensured sustainable and improved use of the newly introduced tool. This enabled staff involvement in adapting the educational sessions as well as the format of the tool itself. We will next look more closely at why the time for senior review and antibiotics have deteriorated over time and continue to look to getting this tool, with automatic prompts on our existing electronic system. The aim of our regular audits will continue to be to improve the appropriate identification of all children who would trigger this tool for suspected sepsis, with subsequent timely management and making any successful changes sustainable.