SickKids piloting new pathway for early recognition and management of sepsis

Increased heart rate. Fever. Mottled skin. Could this be sepsis? This is exactly the question health-care providers at The Hospital for Sick Children (SickKids) are being trained to ask themselves each and every day. This September, Sepsis Awareness Month, marks the beginning of the pilot project for this new clinical management tool.

Despite advances in medicine, sepsis remains a significant cause of morbidity and mortality in children, and the primary cause of death from infection globally. But while sepsis is more easily recognized in adults, it remains difficult to diagnose in children.

“Children have a higher reserve than adults, so they can physiologically compensate for longer without looking as sick. As kids grow their vital signs actually change, so there’s an added level of complexity you just don’t see in adult medicine,” says Dr. Jason Fischer, Interim Division Head, Emergency Medicine Division.

As a new area of focus in the Caring Safely initiative resulting from reviews of serious safety events, SickKids is implementing a new clinical pathway to aid health-care providers in the recognition and management of sepsis on inpatient units. The main focus of Caring Safely is to eliminate preventable harm, and the efforts to improve the early recognition and management of sepsis directly supports that goal.

Building on the momentum created by the successful implementation of a sepsis screening tool in the Emergency Department’s triage process, focus is shifting to the inpatient units where recognizing sepsis can be more difficult with many more factors to consider. Since implementation, the sepsis screening tool at triage in the Emergency Department has been reliably used for almost every patient.  This life-saving process is being measured on SickKids’ Quality Improvement Plan, positioning it as a key metric for safety and quality at the hospital.

It is common sense that with any illness or infection the sooner it is identified and treatment begins, the better the outcome will be. This is especially true in the management of sepsis, where a patient’s condition can deteriorate significantly in a matter of hours, or even minutes. While patients visiting the Emergency Department typically have a length-of-stay of three to eight hours, inpatients can be admitted for days, weeks or months on end.

The goal is to eliminate preventable harm to patients caused by sepsis, but there will be several milestones along the way to indicate progress. “The increased awareness of sepsis has been a huge gain for us in the Emergency Department. It’s at the forefront of everyone’s minds, it’s brought up at every meeting. There isn’t a shift that goes by without someone mentioning sepsis,” says Deb Schonfeld, Physician, Paediatric Emergency Medicine.

The new Sepsis Early Management Pathway draws on the error prevention strategies and safety behaviours that every staff member at SickKids is learning through error prevention education classes. By linking these common behaviours and strategies, such as structured communication using the SBAR technique, a common language of safety is being created in the hospital, allowing staff to communicate effectively while maintaining a focus on patient care.