Pediatric sepsis improvement pathway: Qatar experience

Background: The World Health Organization acknowledges sepsis as a global priority. Healthcare providers and governments have a critical role to play.(1) National sepsis programs have been established in Qatar and in many other countries.(1,2) Here, we share our pediatric sepsis program development and success. Missing signs of early sepsis in children can result in delayed management, complications, and death. A standardized pediatric sepsis pathway based on creating a “THINK SEPSIS” culture incorporating an electronic early warning system and improving effective communication among healthcare providers using standardized tools can help early sepsis recognition, timely management and proper escalation, and ultimately improve patient outcomes.(3–5) Methods: Building on the structure of the adult sepsis program, the pediatric sepsis committee was established in 2017 and a National Pediatric Sepsis Program was created. It is based on a multifaceted approach of education, governance, awareness campaigns, and utilization of an electronic medical record system. Simulation sessions of pediatric sepsis were delivered to fill knowledge gaps. To further pediatric sepsis care in Qatar the following steps were completed: • Established a pediatric sepsis clinical pathway and guideline to be followed in all clinical areas at all times whenever a child is suspected or confirmed to have sepsis, hence avoiding variation of practice and saving valuable time. • Introduced sepsis watchers in the daily safety huddle to facilitate continuity of care and alert staff concerning deteriorating patients. • Provided a standardized pediatric sepsis diagnostic kit with all required investigation equipment and IV access to all concerned units to minimise delays and standardize care (Figure 1). • Unified the pediatric sepsis antibiotics kits in all units with a safe first dose preparation protocol based on the most recent antibiogram to ensure the delivery of the first dose within 60 minutes of pathway activation. • Rolled out an e-learning module which is simple, interactive, and evidence-based for staff to be acquainted with the program and to increase awareness. • Developed an electronic pediatric sepsis order set allowing clinicians to initiate all elements of the sepsis bundle within a few minutes, saving time and ensuring consistency and reliability (Figure 1). Results: 1. The proportion of clinical review, Rapid Response Team activation, and sepsis alerts that were appropriately escalated is 91%. This is an important achievement to ensure timely intervention thus saving lives (Figure 2A). 2. 81% of patients received IV antibiotics within 60 minutes of time zero. This is an essential element of sepsis care bundle (Figure 2B). 3. Pediatric sepsis golden-hour order set was initiated in 26% of cases (Figure 2C). 4. Achieved sepsis bundle compliance of 42%. Conclusion: Evidence suggests that the systematic and supervised implementation of a validated evidence-based pathway for sepsis can reduce mortality and morbidity. Our data demonstrates improvements in some elements of sepsis care such as the escalation of care and early IV antibiotics. However, bundle compliance remains below the international benchmark. The challenges of documentation and early recognition have to be addressed. Progressive implementation, surveillance, and close monitoring is warranted to estimate the real death-to-case ratio in pediatrics sepsis cases.