title: "Beat the Shock Clock": An Interprofessional Team Improves Pediatric Septic Shock Care.
abstract: Ideal care for septic shock (SS) is difficult. This interprofessional quality improvement intervention in a mid-volume pediatric emergency department aimed to reduce time to vascular access, fluid resuscitation, and antibiotics for SS. Intensive education, a care pathway, and an order set were applied. Outcome measures for patients with criteria for SS before and after intervention were compared. There were 43 patients pre-intervention (January 2009 to June 2011) and 63 post-intervention (June 2012 to June 2013). Median time to vascular access decreased from 37 minutes pre-intervention to 24 minutes post-intervention (p = 0.05). Median time to first fluid bolus decreased from 35 to 26 minutes (p = 0.08). Percentage of boluses delivered rapidly by pressure method increased from 21% to 74% (p < 0.0001). Median time to antibiotics decreased from 92 to 55 minutes (p = 0.02). In conclusion, a multimodal, interprofessional quality improvement intervention in a mid-sized pediatric emergency department improved the time to critical interventions for SS.
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA rachel.tuuri@gmail.com.
authors: Rachel E
authors: RE
authors: Tuuri
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: Madeline G
authors: MG
authors: Gehrig
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: Carrie E
authors: CE
authors: Busch
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: Myla
authors: M
authors: Ebeling
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: Kristen
authors: K
authors: Morella
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: Lisa
authors: L
authors: Hunt
authors: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors: W Scott
authors: WS
authors: Russell
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010348:Patient Care Team; D010372:Pediatrics / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D012772:Shock, Septic / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: electronic health records; interprofessional relations and communications; multidisciplinary relations and communications; pediatric emergency medicine; quality improvement; septic shock; severe sepsis