Impact of an evidence-based sepsis pathway on paediatric hospital clinical practice: A quality improvement study

Objectives To assess the impact of implementing a sepsis pathway and education program on key sepsis outcomes and performance targets in a tertiary paediatric hospital. Methods A quality improvement study using a multi-modal screening process and pragmatic clinical definitions. Treatment of all children with septic shock and sepsis without shock 4 months prior to pathway/education package launch was compared with those meeting definitions 8 months post-launch. Results Over the study period, 1483 episodes were screened; 517 episodes met study definitions (171 pre-launch; 346 post-launch). Eighty-two episodes met septic shock definitions (15.9%) and 435 met sepsis without shock definitions (84.1%). A total of 143 episodes pre-launch and 271 episodes post-launch were managed exclusively at Perth Children's Hospital (PCH). Post intervention, the pathway form was utilised in 146 of 271 episodes (53.9%). Pathway/education package introduction was associated with a reduction in the median time from recognition to antibiotic administration (60 [IQR: 26; 115] to 45 min [IQR: 16; 75] for those with septic shock and/or sepsis without shock treated exclusively at PCH; P < 0.001). The proportion receiving antibiotic therapy within recommended timeframes significantly increased (septic shock within 60 min: 70.0% to 92.5%, P < 0.03; sepsis without shock within 180 min; 86.2% to 94.8%, P = 0.005). No statistically significant change in length of stay, intensive care admission, mortality or antibiotic consumption was observed following pathway launch. Conclusions Paediatric sepsis pathway and education package implementation can reduce time to antibiotics in sepsis and aid local data collection and surveillance of patients treated for sepsis.