Beat the Shock Clock An Interprofessional Team Improves Pediatric Septic Shock Care

• Published in: Clinical pediatrics Vol. 55; no. 7; pp. 626 - 638
• Main Authors: Tuuri, Rachel E., Gehrig, Madeline G., Busch, Carrie E., Ebeling, Myla, Morella, Kristen, Hunt, Lisa, Russell, W. Scott
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-06-2016; Westminster Publications, Inc
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Child; Child, Preschool; Emergency medical care; Emergency Service, Hospital; Female; Fluid Therapy - methods; Guideline Adherence; Hospital Mortality; Humans; Infant; Intervention; Length of Stay - statistics & numerical data; Male; Patient Care Team; Pediatrics; Pediatrics - methods; Quality Improvement; Retrospective Studies; Shock, Septic - therapy; Treatment Outcome; pediatric emergency medicine; septic shock; severe sepsis; quality improvement; interprofessional relations and communications; electronic health records; multidisciplinary relations and communications
• ISSN: 0009-9228; 1938-2707
• DOI: 10.1177/0009922815601984

Ideal care for septic shock (SS) is difficult. This interprofessional quality improvement intervention in a mid-volume pediatric emergency department aimed to reduce time to vascular access, fluid resuscitation, and antibiotics for SS. Intensive education, a care pathway, and an order set were applied. Outcome measures for patients with criteria for SS before and after intervention were compared. There were 43 patients pre-intervention (January 2009 to June 2011) and 63 post-intervention (June 2012 to June 2013). Median time to vascular access decreased from 37 minutes pre-intervention to 24 minutes post-intervention (p = 0.05). Median time to first fluid bolus decreased from 35 to 26 minutes (p = 0.08). Percentage of boluses delivered rapidly by pressure method increased from 21% to 74% (p < 0.0001). Median time to antibiotics decreased from 92 to 55 minutes (p = 0.02). In conclusion, a multimodal, interprofessional quality improvement intervention in a mid-sized pediatric emergency department improved the time to critical interventions for SS.