Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study.
Each year in the United States, 72,000 pediatric patients develop septic shock, at a cost of $4.8 billion. Adherence to practice guidelines can significantly reduce mortality; however, few methods to compare performance across a spectrum of emergency departments (EDs) have been described.



We employed standardized, in situ simulations to measure and compare adherence to pediatric sepsis guidelines across a spectrum of EDs. We hypothesized that pediatric EDs (PEDs) would have greater adherence to the guidelines than general EDs (GEDs). We also explored factors associated with improved performance.



This multi-center observational study examined in situ teams caring for a simulated infant in septic shock. The primary outcome was overall adherence to the pediatric sepsis guideline as measured by six subcomponent metrics. Characteristics of teams were compared using multivariable logistic regression to describe factors associated with improved performance.



We enrolled 47 interprofessional teams from 24 EDs. Overall, 21/47 teams adhered to all six sepsis metrics (45%). PEDs adhered to all six metrics more than GEDs (93% vs. 22%; difference 71%, 95% confidence interval [CI] 43-84). Adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. In a multivariable regression model, only greater composite team experience had greater adjusted odds of achieving an adherent sepsis score (adjusted odds ratio 1.38, 95% CI 1.01-1.88).



Using standardized in situ scenarios, we revealed high variability in adherence to the pediatric sepsis guideline across a spectrum of EDs. PEDs demonstrated greater adherence to the guideline than GEDs; however, in adjusted analysis, only composite team experience level of the providers was associated with improved guideline adherence.
Department of Pediatrics, Columbia University Medical Center, New York Presbyterian Morgan Stanley Children's Hospital of New York, New York, New York.
David O
DO
Kessler
Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
Barbara
B
Walsh
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Travis
T
Whitfill
Department of Pediatrics, Johns Hopkins University, St. Petersburg, Florida.
Robert A
RA
Dudas
Department of Pediatrics, Long Island Jewish Medical Center, New Hyde Park, New York.
Sandeep
S
Gangadharan
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Marcie
M
Gawel
Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
Linda
L
Brown
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Marc
M
Auerbach
D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008020:Life Support Care / Q000592:standards; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012151:Resuscitation / Q000592:standards*; D012772:Shock, Septic / Q000628:therapy*; D014481:United States
emergency medicine; pediatrics; quality control; sepsis; simulation