Optimizing Recognition and Management of Patients at Risk for Infection-Related Decompensation Through Team-Based Decision Making

Abstract

Introduction: Pediatric sepsis is a leading cause of death among children. Electronic alert systems may improve early recognition but do not consistently result in timely interventions given the multitude of clinical presentations, lack of treatment consensus, standardized order sets, and inadequate interdisciplinary team-based communication. We conducted a quality improvement project to improve timely critical treatment of patients at risk for infection-related decompensation (IRD) through team-based communication and standardized treatment workflow.

Methods: We evaluated children at risk for IRD as evidenced by the activation of an electronic alert system (Children at High Risk Alert Tool [CAHR-AT]) in the emergency department. Outcomes were assessed after multiple improvements including CAHR-AT implementation, clinical coassessment, visual cues for situational awareness, huddles, and standardized order sets.

Results: With visual cue activation, initial huddle compliance increased from 7.8% to 65.3% ( p < .001). Children receiving antibiotics by 3 hours postactivation increased from 37.9% pre-CAHR-AT to 50.7% posthuddle implementation ( p < .0001); patients who received a fluid bolus by 3 hours post-CAHR activation increased from 49.0% to 55.2% ( p = .001).

Conclusions: Implementing a well-validated electronic alert tool did not improve quality measures of timely treatment for high-risk patients until combined with team-based communication, standardized reassessment, and treatment workflow.

Figure 1.

Stoplight activation algorithm used to determine stoplight color during dyad huddle. CAHR = Children at High Risk.

Figure 2.

CAHR-AT assessment flowchart showing the emergency department workflow related to the CAHR-AT. CAHR-AT = Children at High Risk Alert Tool; RN = registered nurse.

Figure 3.

Percent of CAHR red and yellow light patients with an initial dyad huddle completed. CAHR = Children at High Risk.

Figure 4.

A, Percent of patients with CAHR-AT activation who received IV/IM antibiotics by 3 hours postactivation. B, Percent of patients with CAHR-AT activation who received IVFB by 3 hours postactivation. CAHR-AT = Children at High Risk Alert Tool; IM = intramuscular; IV = intravenous; IVFB = IV fluid bolus.