Sepsis: an Update on Current Improvement Efforts
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Patient Safety (Ma Coffey, Section Editor)
Sepsis: an Update on Current Improvement Efforts Deborah Schonfeld, MD, FRCPC1,2,* Raina Paul, MD, FAAP3 Address *,1 Division of Emergency Medicine, The Hospital for Sick Children, 525 University Avenue, Suite 1218, Toronto, Ontario, M5G 2L3, Canada Email: [email protected] 2 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada 3 Pediatric Emergency Department, Advocate Children’s Hospital, Park Ridge and Oak Lawn, IL, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Patient Safety Keywords Sepsis I Septic shock I Pediatric I Quality improvement
Abstract Purpose of the Review Sepsis remains a leading cause of pediatric deaths worldwide. The lack of adherence to internationally recognized care guidelines has made this area ripe for quality improvement (QI). The last decade has seen a surge in sepsis-related QI work from local to national levels which will have significant implications for pediatric health outcomes. Recent Findings Thoughtfully developed quality of care measures pertaining to the assessment and management of pediatric sepsis are instrumental to identifying and addressing gaps in care. Key drivers include timely recognition and rapid delivery of essential treatments, and therefore, the majority of QI work to date has focused on systematic screening and protocolized bundled care. Summary QI efforts in pediatric sepsis continue to evolve as new evidence and technologies emerge. Ongoing local efforts have been strengthened by multicenter collaboratives which have focused on standardizing definitions and harnessing the power of electronic health records (EHR) to improve data collection and reporting.
Introduction Septic shock remains a leading cause of morbidity and mortality worldwide. In the USA, pediatric severe sepsis accounts for over 75,000 hospitalizations annually and has a mortality rate of 8–12% [1–3]. Patient survival
depends largely on rapid recognition and aggressive resuscitation. Although national treatment guidelines have existed for almost 2 decades, this knowledge has not been reliably translated into clinical practice. Over
Patient Safety (Ma Coffey, Section Editor) the past few years, hospitals, professional organizations, patient advocacy groups and even legislative bodies have advocated for implementation of systems which reliably improve the recognition and management of
pediatric sepsis. This has led to a surge of awareness among healthcare providers and has inspired a concerted collaborative effort to uncover barriers to highquality care and improve adherence to best practice.
Sepsis Best Practice Current consensus definitions define severe sepsis as sepsis with two or more organ dysfunctions and septic shock as sepsis in the presence of cardiovascular dysfunction [4•]. These definitions are currently under revision but not yet published. In 2002, the American College of Critical Care Medicine (ACCM) published its original recommendations “Practice Para
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