Clinical Practice: Using a Best Evidence Sepsis Scoring Tool to Identify and Manage Pediatric Patients With Severe Sepsis in the Emergency Department

Abstract

Severe sepsis and septic shock are leading causes of pediatric morbidity and mortality, resulting in prolonged hospitalization and increased healthcare costs. 1,2 Delays in recognition of sepsis, vascular access, and administration of fluids and antibiotics are major barriers within pediatric emergency departments (ED). 3,4 Severe sepsis is defined as symptoms suspicious of infection plus signs of organ dysfunction or tissue hypoperfusion. 5 A sepsis trigger tool at triage can identify vital sign abnormalities of severe sepsis, alert ED resources, and rapidly begin the sepsis protocol. 3 Annually, almost 100,000 pediatric patients present to the ED with signs of severe sepsis. 6. Using the concept of “PIRO” (predisposition, infection, response, and organ dysfunction), the sepsis tool was adapted to identify pediatric patients at risk for sepsis with signs of infection, age-related abnormal vital signs, and signs of organ dysfunction. With 5 or greater score (maximum score of 16), a “sepsis alert” was paged. A multidisciplinary team was mobilized: ED nurse, ED paramedic, physician, respiratory therapist, and child life specialist. Using a nurse-initiated pathway, patient was placed on cardiac apnea monitor, pulse oximeter, and oxygen, vital sign monitoring was begun, intravenous (IV) line insertion with lab work was obtained, and weight-based IV fluid bolus was initiated with antibiotics anticipated. Sepsis scores were repeated after interventions or with status changes. An ED sepsis committee was formed to audit charts and educate staff on the sepsis tool. From January 2014 through April 2015, median times for triage-to-IV fluid bolus improved from 65 to 51 min and triage-to-antibiotic times improved from 137 to 80 min. With early recognition and treatment of sepsis, ED experienced improved patient mortality rates, shorter hospital stays, and decreased hospital costs. The successes of multidisciplinary interventions, effective communication, increased awareness, and staff compliance have led to decreases in triage-to-bolus and triage-to-antibiotic times. The tool was accurate in identifying severe sepsis; the admission rate for positive sepsis alerts was 60%. View a PDF of this poster presentation.