Electronic Screening Tool and Shock Huddle Process for Children at Risk for Sepsis

Abstract

Background:Nemours created an electronic screening tool for severe sepsis/septic shock (SS/SS) called the Shock Score (Table 1). At a threshold score, a Shock Huddle (SH) is initiated, and the patient is assessed by the Shock RN (pediatric intensive care unit nurse with enhanced training on sepsis) with the primary team (Fig. 1).Objectives:We sought to describe the characteristics of the score and the demographics of patients who underwent an SH.Methods:One thousand seven hundred forty-eight admissions were screened over 109 days. Cases of SS/SS were identified by chart review of patients with an elevated score, transfers to the intensive care unit via the medical emergency team, and patients with International Classification of Disease-10 codes of R65.20/R65.21. A subset (1,323 admissions) was used to evaluate the score characteristics.Results:There were 58 cases of SS/SS. Five cases were missed by the score due to a missed high risk condition or delay in documentation. One hundred twenty SH were completed on 51 unique patients. Seventy-three percent had a high risk condition. Nearly 40% of SHs involved diagnostic or therapeutic intervention (Table 2). The score had an area under the receiver operating characteristic curve (AUROC) 0.8, sensitivity 0.9 (0.72–0.97), specificity 0.44 (0.35–0.54), negative predictive value 0.95 (0.84–0.99), and positive predictive value 0.28 (0.19–0.38).Conclusions/Implications:The score demonstrates acceptable characteristics as a screening tool to identify children at risk for sepsis. Nearly 40% of SHs included a diagnostic or therapeutic intervention. Misses of the score were related to high risk conditions that were not scored by the electronic medical record and delays in documentation.