Sepsis Alert

UNM Pediatric Specialists Seek to More Rapidly Identify Bacterial Infection in Children

Sepsis – a life-threatening immune response to a surging bacterial infection – is often seen in hospitalized children, and doctors know it’s important to catch it before it flares out of control. 

Pediatric specialists at The University of New Mexico Hospital have a received a grant award to implement a new set of procedures to rapidly identify and respond to early signs of sepsis in children.

The $50,000 Quality Improvement Seed Grant from the Society to Improve Diagnosis in Medicine will provide funding for staff to develop and disseminate the new process to teams across the UNM Children’s Hospital. 

It is a joint effort spearheaded by Anna Duran, MD, the hospital’s associate chief medical officer for children’s services, Anjali Subbaswamy, MD, Department of Pediatrics quality and safety officer, and Rachel Tuuri, MD, chief of the Division of Pediatric Emergency Medicine, who are the principal and co-investigators on the grant.

 

Duran recalls her experience as an attending physician treating a young patient whose clinical signs of early sepsis were not identified.

“I realized we do not have a cohesive system in place to facilitate early recognition of sepsis,” she says. “From discussion with our group we felt there was room to standardize an approach to pediatric sepsis across the institution. This meant collaboration between departments, allowing us to create a unified system for sepsis care in the outpatient and inpatient settings.”

The first step in the UNM team’s plan is developing an automated pediatric sepsis screening tool that incorporates changes in a child’s vital signs, immune status and other high-risk conditions, and when certain criteria are met, it will lead to a team assessment for further care. This starts the discussion and decision to treat or not treat for sepsis. 

“Because early signs of sepsis in children are often subtle, good screening systems and team assessments are important tools to expedite care,” Tuuri says. “Sepsis is time-dependent, and we know that earlier detection and treatment improves a child’s chances of surviving the illness.

 

The tricky thing about pediatric sepsis is that it’s not so obvious at the beginning. When it’s obvious, you’re already behind

— Rachel Tuuri, MD

“The tricky thing about pediatric sepsis is that it’s not so obvious at the beginning. When it’s obvious, you’re already behind. You have to play huge catch-up.”

A key element of the project is implementing a system-wide effort that includes inpatient pediatric providers and pediatric emergency medicine providers, Subbaswamy says.

“Collaboration on this scale is the best way to impact outcomes on this important medical issue,” she says. The effort to improve sepsis care at UNMH is shared with many hospitals nationwide because it is a disease that is costly for patients, hospitals and communities.

“We know that every year in the U.S., 75,000 children are hospitalized for sepsis and 7,000 children die of from it,” Subbaswamy said. “Sepsis is also incredibly expensive, costing $65,000 to $85,000 per hospitalization.” Although sepsis is more common in children with complex medical conditions, it develops in healthy kids too.

Next steps in the project will include development of culturally sensitive scripts for families, evidence-based care pathways, team education and systems to monitor performance in care delivery.  The grant will fund an analyst who can help develop systems to answer whether the project is meeting its goals in improving time to sepsis care.

“When it comes to sepsis,” Duran says, “we believe that team and family partnerships, knowledge and data will be powerful tools for change.”

Research and quality improvement support for the project is provided by a team that includes Hengameh Raissy, PharmD, vice chair for research in Pediatrics, Elizabeth Yakes Jimenez, RD, PhD, associate professor of Pediatrics and Internal Medicine, Kara McKinney, MA, and Francesca Kelly.

This project is supported by The Society to Improve Diagnosis in Medicine under a grant from the Gordon and Betty Moore Foundation.