title: Implementation of an Inpatient Pediatric Sepsis Identification Pathway.
abstract: OBJECTIVE
  Early identification and treatment of severe sepsis and septic shock improves outcomes. We sought to identify and evaluate children with possible sepsis on a pediatric medical/surgical unit through successful implementation of a sepsis identification pathway.
  
  
  METHODS
  The sepsis identification pathway, a vital sign screen and subsequent physician evaluation, was implemented in October 2013. Quality improvement interventions were used to improve physician and nursing adherence with the pathway. We reviewed charts of patients with positive screens on a monthly basis to assess for nursing recognition/physician notification, physician evaluation for sepsis, and subsequent physician diagnosis of sepsis and severe sepsis/septic shock. Adherence data were analyzed on a run chart and statistical process control p-chart.
  
  
  RESULTS
  Nursing and physician pathway adherence of >80% was achieved over a 6-month period and sustained for the following 6 months. The direction of improvements met standard criteria for special causes. Over a 1-year period, there were 963 admissions to the unit. Positive screens occurred in 161 (16.7%) of these admissions and 38 (23.5%) of these had a physician diagnosis of sepsis, severe sepsis, or septic shock. One patient with neutropenia and septic shock had a negative sepsis screen due to lack of initial fever.
  
  
  CONCLUSIONS
  Using quality improvement methodology, we successfully implemented a sepsis identification pathway on our pediatric unit. The pathway provided a standardized process to identify and evaluate children with possible sepsis requiring timely evaluation and treatment.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York chanda.bradshaw@nyumc.org.
authors.forename: Chanda
authors.initials: C
authors.lastname: Bradshaw
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Ilyssa
authors.initials: I
authors.lastname: Goodman
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rosenberg
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bandera
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Arthur
authors.initials: A
authors.lastname: Fierman
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York.
authors.forename: Bret
authors.initials: B
authors.lastname: Rudy
mesh_terms: D002648:Child; D019091:Critical Pathways; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008505:Medical Staff, Hospital; D009518:New York; D009741:Nursing Staff, Hospital; D010348:Patient Care Team; D058996:Quality Improvement; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy*