Using Distance-Based Methods to Drive Coordinated Implementation of Pediatric Sepsis Protocols at Community Hospitals Affiliated with an Academic Pediatric Medical Center

BACKGROUND: Under the umbrella of an outreach division of hospital-based medicine, our academic pediatric medical center partners with 15 community hospitals. Most partner sites are staffed by children’s hospital pediatric hospitalists with goals of improving and standardizing quality cares while maintaining respect for the local hospital variations in geography, administration, resources, and EMR. In 2016, the state government mandated pediatric sepsis protocols in all hospitals that treat children. The aim of this project was to implement evidence based pediatric sepsis protocols on 100% of inpatient pediatric units and 100% of emergency departments at 9 community hospitals affiliated with the academic pediatric medical center by June of 2018. METHODS: Establishment of a committee connecting community sites to each other and the academic center. Committee membership included hospitalists from partnership sites, the academic center, and nursing education. Distance communication methods were maximized. Barrier analysis was done via conference call and an anonymous controlled facilitator process - borrowing from the Delphi method - prioritized key drivers. PDSA cycles were conducted at the committee level and action executed at partnership sites as smaller cycles within the local working group. Feedback from the sites fed back into the committee to initiate the next improvement cycle. The primary outcome measure was the proportion of hospital service lines (ED and inpatient pediatrics) at 9 participating community hospitals with an active evidence based protocolized pediatric sepsis screen and treatment pathway. Data was tracked for 20 months and run charts were reviewed monthly. RESULTS: We included 16 service lines (8 EDs and 8 inpatient pediatric units) at 9 community partnership hospitals. The proportion of service lines with active pediatric sepsis screens increased from 0% at the start of our initiative to 94% during the 20 months after the start of our initiative (p< 0.001). The proportion of service lines with a protocolized treatment pathway increased from 0% to 100% during the same 20 months (p< 0.001). At 6 non-participating community partnership hospitals, the proportion with pediatric sepsis screens and protocolized treatment pathways increased from 43% to 71%. CONCLUSION: Participation in a centralized QI infrastructure utilizing distance methods to support QI methodology and communication between partnership community hospitals corresponded to an increased proportion of community hospitals with active pediatric sepsis screens and protocolized treatment pathways. Factors contributing to success included political will infused by state mandate, commitment to distance methods to engage stakeholders, and relative relief from the isolation that can inhibit community QI efforts. The next phase is evaluation of the performance of pediatric sepsis screens for detection of sepsis at partnership community hospitals. Despite low patient volumes at individual sites, meta-analysis of participating sites may allow for meaningful conclusions about pediatric sepsis screening in a community hospital setting.

• Copyright © 2019 by the American Academy of Pediatrics