In December of 2018, Lucile Packard Children’s Hospital (LPCH) went live with a new sepsis algorithm to align its standard of care with national recommendations. Clinical evidence is clear that once a patient is diagnosed as septic (the body’s maladaptive response to a severe infection), early delivery of care within the “golden hour” improves patient outcomes. What is more difficult to measure, however, is adherence to these guidelines, which prescribe simple interventions of antibiotics and aggressive fluid resuscitation within the golden hour.
With guidance from Dr. Saraswati Kache, we developed an EMR-based infrastructure that measures and tracks process improvements due to the implementation of the Sepsis/Septic Shock Pathway at LPCH. We identified a time zero and pulled relevant timestamps (fluids, antibiotics, and labs) from the electronic medical record with the help of Andrew Ward and his work for the CLABSI project. With this data, we measured how often action is taken in a timely manner and developed a Tableau dashboard to present this information.
Compared to painstaking manual review, the automated data extraction method identified 95% of fluid boluses and 60% of antibiotic administrations. We have also standardized this process with the hope that LPCH can assess its adherence to the algorithm on a monthly basis and continue to improve its response to sepsis.
