An electronic alert system in the emergency department at Children’s Hospital of Philadelphia, coupled with a clinician “sepsis huddle” at a child’s bedside, is helping physicians and nurses more quickly identify and assess children who are developing the life-threatening infection.
“Early and accurate recognition of pediatric sepsis is challenging because many children present initially without overt signs of shock,” says Fran Balamuth, MD, an emergency physician and lead author of a quality improvement study published in the Annals of Emergency Medicine. “Identifying the rare child with severe sepsis or septic shock from among many non-sepsis patients with fever and rapid heart rate who present to a pediatric emergency department is truly akin to the proverbial needle in a haystack.”
The electronic alert system checks for a series of warning signs being presented by a patient, researchers explain in the study. These include elevated pulse rate or hypotension, concern for infection and at least one of the following—abnormal capillary refill, abnormal mental status or a high-risk condition. A positive electronic sepsis alert prompts a team huddle to determine the need for a sepsis protocol.
Researchers at the hospital reviewed electronic health records of 182,509 emergency department visits between June 2013 and May 2014, finding that 326 patients were treated for severe sepsis within 24 hours—the electronic alert system increased detection from 83 percent to 96 percent.
Only 50 years ago, 90 percent of patients with sepsis did not survive. Today, with better understanding of the threat, improved antibiotics and resuscitative therapies such as intravenous fluids and medications to increase blood pressure and oxygen, many patients survive. The mortality rate for children, however, remains at about 10 percent. The complete study is available for purchase here.