Improving Screening for Sepsis in the Pediatric Emergency Department

INTRODUCTION: Early recognition of sepsis is critical to providing efficient and effective care for a potentially life-threatening condition. When automated sepsis screening is not available, front-line ED providers, often bedside nurses, must incorporate screening into their busy workflow. The aim of this project was to increase the completion of an ED-based sepsis screening tool in at-risk patients from a baseline of 5–15% to > 50% in 3 months. METHODS: A key driver diagram was developed (Fig. 1). We used statistical process control to evaluate changes in sepsis screening over time. RESULTS: At baseline, 15% of ED patients with fever were screened using the electronic, nurse-initiated tool. We noted a single point outside the upper control limit (special cause variation) in October 2015 concurrent with implementation of a clinical pathway for septic shock, but this improvement was not sustained over time. Special cause was again noted with a shift of 8 points above the centerline in June 2016 following an educational push and reminders for ED nurses, increasing overall screening to 30%. Further improvement (special cause) was noted after significant modifications were made to the screening tool in June 2017 (Fig. 2). CONCLUSION: Quality improvement methodologies (development of a SMART aim, key driver diagram, and multiple plan-do-study-act cycles) led to improvement in screening at-risk patients for sepsis.