Standard Work Optimizes Outcomes (Again!)

November 2015

​​Is this Sepsis? Treatment and Recognition Program Improves Child Health Outcomes 

A multidisciplinary team at Children’s Hospital Colorado is advancing the identification and treatment of pediatric sepsis.

Dr. Halden Scott​ is medical director of the Sepsis Treatment and Recognition Program. Since 2012, she’s been dedicated to creating effective processes for physicians, nursing and pharmacy staff in cases of known and suspected sepsis. It’s a challenge, considering how complicated sepsis can be—particularly in the pediatric patient. 

“What we know about pediatric sepsis continues to evolve as we adapt new protocols to increase the effectiveness of treatment,” she said. 

The team, which involves nearly 30 providers representing multiple disciplines, developed a two-tier system for resuscitating active sepsis cases and suspected sepsis, starting in the emergency department. 

They started by acknowledging the existing barriers to proper treatment. First, there isn’t an effective, objective screening test for sepsis. ​

“Most of what we know about sepsis is from research done on adults. And what’s known about sepsis in child health is largely based on research in the most vulnerable patient populations,” Dr. Scott explained. 

Second, they recognized that implementing new protocols surrounding suspected sepsis could have the unintended consequence of over-treating patients, which for sepsis means using unnecessary antibiotics. 

“Diagnosis is tricky when the evidence isn’t fully clear,” said Dr. Scott. “We focused our program on perfecting treatments for sepsis once it was identified. We didn’t want to over-treat or pull the trigger too fast.” 

STAT and Yellow Protocols 

The team standardized the steps to be taken using a two-tier system: The STAT protocol outlines order sets for known cases of sepsis; The Yellow protocol standardizes the events that must occur when sepsis is suspected. (Chart shown below: Outline of the two-tier sepsis treatment protocol)

“It used to be a lot of steps. Now we start with a standard activation page that goes out through all units involved. Everyone knows exactly what to do, and it’s the same process every time. Anyone can activate the pathways.” 

 Dr. Scott said the team maximized the capacity of Epic. “We pushed to make our order set as good as it possibly could be,” she explained. “Orders are auto-populated, making it truly ‘one click’ for efficiency and accuracy. 

Improved Outcomes 

The focus on process improvement has impacted patient outcomes. “It’s incredible,” Dr. Scott said. “Length of stay has gone down by 50 percent for all patients. STAT patients have improved outcomes and time to antibiotics has greatly improved.” 

Mortality has also been impacted, with rates lower than those seen across the nation. “I review any sepsis mortality and try to find out if we could do something better in the ED to prevent something from happening. Most cases represent progression of severe underlying disease. In our reviews, we’re finding few preventable outcomes,” she said. 

Keys to Program Success 

Dr. Scott can’t say enough about the support the institution has given the team and how ready they were for improving sepsis treatment. She also credits the emergency department team for being receptive to change. 

“The ED is a challenging place to get new policies out to everyone—there’s a large staff and everyone is coming and going from shifts. Our emergency department has great nurse educators,” she said. “Pharmacy is also amazing. They own their role in the process and take pride in it.” 

Proper data capturing is another aspect that’s essential to the program’s success. “We have an electronic sepsis registry that allows us to follow our metrics over time. We’re able to review and report data both nationally and to the individual provider.” 

Dr. Scott is proud of the strides her team has made in improving the processes surrounding sepsis treatment. The multidisciplinary team has shared their findings in their respective forums nationally. In the coming months, the team will be taking what they’ve learned in the emergency setting and increasing the focus on the inpatient setting. 

“We’ve teamed up with great people doing this work nationally,” she said. “We’ll be working not just to improve care, but also to discover new things that will help everyone do better in the future.”