Pediatric Resident Connecticut Children's Medical Center West Hartford, Connecticut, United States
Background: Pediatric sepsis outcomes can be improved with prompt recognition and timely intervention. A resident-led QI group was formed to reduce variation in timing of critical interventions. Our institution utilizes a best practice alert (BPA) within the electronic medical record to assist providers in identifying patients at risk of sepsis. When a BPA is ignored, it results in recurrent provider BPAs. A survey of residents revealed that 57% reported a huddle was “almost never” initiated following a sepsis BPA, most commonly due to “alert fatigue.” These results suggest an area for improvement in first response to a sepsis BPA. Objective: By implementing a resident-nurse sepsis huddle in the PICU to address the first BPA alert, we aim to reduce the number of sepsis BPAs by 20% by March 15, 2024. Design/Methods: This QI initiative takes place in the PICU at CT Children’s. IRB approval is deferred, as this involves no randomization and only initiation of a process, the “sepsis huddle”, to discuss the BPA alert. Pre-intervention data collected includes team member action in response to a sepsis BPA. A flow diagram details the ideal flow from BPA alert to huddle. A key driver diagram details the AIM, key drivers to achieve that aim, and change strategies to implement a huddle. A fishbone diagram details the inputs that lead to the ideal outcome. Test of change using Plan, Do, Study, Act (PDSA) cycles will test changes to the process. Team members will receive education on recommended process improvement. Process metrics, including total BPA alerts and percent of repeat BPA alerts for each discipline, will be recorded on a weekly basis, and graphed on C -and P- statistical process control (SPC) charts. The outcome metric of time to the first antibiotic order will be measured and graphed in a SPC I-chart. SPC chart rules will be used to define special cause variation. A post intervention survey will assess resident perceptions on the revised sepsis bundle. We will use a secure web-based, data capture and archiving system (REDCap)® for data capture and Minitabs® to graph SPC charts.
