Feinstein Yael, Kogan Slava, Dreiher Jacob, Noham Ayelet, Harosh Shimrat, Lecht Jenia, Sror Tzipi, Cohen Nurit, Bar-Yosef Eileen, Hershkowitz Eli, Lazar Isaac, Schonmann Yochai, Greenberg David, Danino Dana
Pediatric Intensive Care Unit, Soroka University Medical Center, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Itzchak-Rager Ave, Beer Sheva 8410501, Israel.
Int J Qual Health Care. 2023 Feb 22;35(1). doi: 10.1093/intqhc/mzad006.
Sepsis is a leading cause of mortality in children. Utilizing a screening tool for early recognition of sepsis is recommended. Our centre had no screening tool for sepsis nor a standardized protocol for sepsis management. In December 2020, a screening algorithm for sepsis was implemented. The algorithm consisted of vital signs measurements in children with an abnormal body temperature, a pop-up alert, nurse's and physician's evaluation, and activation of a workup protocol. The project's primary aim was to increase vital signs measurement rates in hospitalized children with abnormal body temperature from 40% to >90% within 6 months, by 1 June 2021, and sustain until 31 December 2021. Adherence to the algorithm and performance were monitored during 2021, and the outcomes were compared to the preceding 5 years and a control ward. The alert identified 324 children and 596 febrile episodes. Vital signs measurement adherence increased from 42.7% to >90% in 2 months. A nurse evaluated 86.4% of episodes, and a physician evaluated 83.0% of these. Paediatric intensive care unit (PICU) admission rates were lower in the intervention period vs. the pre-intervention period vs. the control ward (4.6% vs. 5.6% vs. 6.0%, respectively); the median PICU length of stay was shorter in the intervention vs. the control ward [2.0 (IQR 1, 4) vs. 5.5 (IQR 2, 7), respectively]. These differences were not statistically significant. During the intervention period, the adherence to vital signs measurements reached the goal of >90%. The alert system prompted an evaluation by caregivers and management according to the protocol. Further monitoring is needed to improve outcomes.
脓毒症是儿童死亡的主要原因。建议使用筛查工具以早期识别脓毒症。我们中心既没有脓毒症筛查工具，也没有脓毒症管理的标准化方案。2020年12月，实施了一项脓毒症筛查算法。该算法包括对体温异常儿童的生命体征测量、弹出警报、护士和医生的评估以及启动检查方案。该项目的主要目标是在2021年6月1日前的6个月内，将住院体温异常儿童的生命体征测量率从40%提高到>90%，并维持到2021年12月31日。在2021年期间监测了对该算法的依从性和执行情况，并将结果与前5年及一个对照病房进行了比较。该警报识别出324名儿童和596次发热发作。生命体征测量的依从性在2个月内从42.7%提高到>90%。护士评估了86.4%的发作情况，医生评估了其中的83.0%。与干预前时期和对照病房相比，干预期间儿科重症监护病房（PICU）的入院率较低（分别为4.6%、5.6%和6.0%）；与对照病房相比，干预期间PICU的中位住院时间较短[分别为2.0（IQR 1，4）和5.5（IQR 2，7）]。这些差异无统计学意义。在干预期间，生命体征测量的依从性达到了>90%的目标。警报系统促使护理人员和管理人员按照方案进行评估。需要进一步监测以改善结果。
