Optimizing Recognition and Management of Patients at Risk for Infection-Related Decompensation Through Team-Based Decision Making
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Association for Healthcare Quality..
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:45 |
|---|---|
| Enthalten in: |
Journal for healthcare quality : official publication of the National Association for Healthcare Quality - 45(2023), 2 vom: 30. März, Seite 59-68 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Martinez, Elizabeth M [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 03.03.2023 Date Revised 10.07.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1097/JHQ.0000000000000363 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM345584481 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM345584481 | ||
| 003 | DE-627 | ||
| 005 | 20231226025406.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/JHQ.0000000000000363 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1151.xml |
| 035 | |a (DE-627)NLM345584481 | ||
| 035 | |a (NLM)36041070 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Martinez, Elizabeth M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Optimizing Recognition and Management of Patients at Risk for Infection-Related Decompensation Through Team-Based Decision Making |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 03.03.2023 | ||
| 500 | |a Date Revised 10.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Association for Healthcare Quality. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Sepanski, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a Jennings, A Dawn |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, James M |e verfasserin |4 aut | |
| 700 | 1 | |a Cholis, Thomas J |e verfasserin |4 aut | |
| 700 | 1 | |a Dominy, Meaghan E |e verfasserin |4 aut | |
| 700 | 1 | |a Devlin, Sanaz B |e verfasserin |4 aut | |
| 700 | 1 | |a Eilers, Lindsay Floyd |e verfasserin |4 aut | |
| 700 | 1 | |a Zaritsky, Arno L |e verfasserin |4 aut | |
| 700 | 1 | |a Godambe, Sandip A |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal for healthcare quality : official publication of the National Association for Healthcare Quality |d 1992 |g 45(2023), 2 vom: 30. März, Seite 59-68 |w (DE-627)NLM091578388 |x 1945-1474 |7 nnns |
| 773 | 1 | 8 | |g volume:45 |g year:2023 |g number:2 |g day:30 |g month:03 |g pages:59-68 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/JHQ.0000000000000363 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 45 |j 2023 |e 2 |b 30 |c 03 |h 59-68 | ||