Development of a Quality Improvement Learning Collaborative to Improve Pediatric Sepsis Outcomes.

Pediatric sepsis is a major public health problem. Published treatment guidelines and several initiatives have increased adherence with guideline recommendations and have improved patient outcomes, but the gains are modest, and persistent gaps remain. The Children's Hospital Association Improving Pediatric Sepsis Outcomes (IPSO) collaborative seeks to improve sepsis outcomes in pediatric emergency departments, ICUs, general care units, and hematology/oncology units. We developed a multicenter quality improvement learning collaborative of US children's hospitals. We reviewed treatment guidelines and literature through 2 in-person meetings and multiple conference calls. We defined and analyzed baseline sepsis-attributable mortality and hospital-onset sepsis and developed a key driver diagram (KDD) on the basis of treatment guidelines, available evidence, and expert opinion. Fifty-six hospital-based teams are participating in IPSO; 100% of teams are engaged in educational and information-sharing activities. A baseline, sepsis-attributable mortality of 3.1% was determined, and the incidence of hospital-onset sepsis was 1.3 cases per 1000 hospital admissions. A KDD was developed with the aim of reducing both the sepsis-attributable mortality and the incidence of hospital-onset sepsis in children by 25% from baseline by December 2020. To accomplish these aims, the KDD primary drivers focus on improving the following: treatment of infection; recognition, diagnosis, and treatment of sepsis; de-escalation of unnecessary care; engagement of patients and families; and methods to optimize performance. IPSO aims to improve sepsis outcomes through collaborative learning and reliable implementation of evidence-based interventions.

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Copyright © 2021 by the American Academy of Pediatrics.

Déclaration de conflit d'intérêts

POTENTIAL CONFLICT OF INTEREST: Multiple authors, as members of the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes Steering Committee, received travel reimbursements after attendance at biannual leadership meetings (Drs Auletta, Balamuth, Brilli, Depinet, Hueschen, Huskins, Kandil, Larsen, Macias, Mack, Niedner, Paul, Razzaqi, Schafer, Scott, Silver, and Stalets, and Ms Campbell, Ms Dykstra-Nykanen and Ms Wathen). Dr Scott’s institution is receiving ongoing career development salary support from the Agency of Healthcare Research and Quality (K08HS025696). Dr Scott’s institution is receiving ongoing grant support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development for a research grant (R01HD087363). Dr Huskins reports receiving a consulting fee from ADMA Biologics, Inc. Dr Fitzgerald (collaborator) reports that, in the past, she received support as a coinvestigator on National Institutes of Health grant R43HD096961, and currently, she receives support as a coinvestigator on National Institutes of Health grant K23DK119463. Ms Wilson (collaborator) reports receiving travel reimbursements for conference presentations for the American Society of Pediatric Nephrology and receiving an award from the American Association of Critical Care Nurses in 2017; the other authors have indicated they have no potential conflicts of interest to disclose.