Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A Multicenter, Cross-Sectional Observational In Situ Simulation Study

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• 作者：David O. Kessler ; MD ; MSci ; faap^&lowast ; ; ; Barbara Walsh ; MD^&dagger ; ; Travis Whitfill ; MPH^&Dagger ; ; Sandeep Gangadharan ; MD^§ ; ; Marcie Gawel ; MSN^&Dagger ; ; Linda Brown ; MD ; MSCE^‖ ; ^¶ ; ; Marc Auerbach ; MD ; MSci^&Dagger ; ; for the INSPIRE ImPACTS investigators¹
• 关键词：sepsis ; simulation ; pediatrics ; emergency medicine ; quality control
• 刊名：Journal of Emergency Medicine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：50
• 期：3
• 页码：403-415.e3
• 全文大小：523 K

文摘

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.

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.