Raina Paul1, Matthew Niedner2, Richard Brilli3, Charles Macias4, Ruth Riggs5, Frances Balamuth6, Holly Depinet7,8, Gitte Larsen9, Charlie Huskins10, Halden Scott11,12, Gloria Lucasiewicz5, Melissa Schaffer13, Heidi Gruhler DeSouza5, Pete Silver14, Troy Richardson5, Leslie Hueschen15, Deborah Campbell16, Beth Wathen11,12, Jeffery J Auletta17. 1. Division of Emergency Medicine, Advocate Children's Hospital, Park Ridge, Illinois; raina159@gmail.com. 2. Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, Michigan. 3. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio. 4. Division of Pediatric Emergency Medicine, Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio. 5. Children's Hospital Association, Lenexa, Kansas. 6. Department of Pediatrics, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 7. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 8. Department of Pediatrics, School of Medicine, University of Cincinnati, Cincinnati, Ohio. 9. Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah. 10. Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota. 11. Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado. 12. Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado. 13. Department of Pediatrics, Upstate Medical University, Syracuse, New York. 14. Department of Pediatrics, Zucker School of Medicine at Hofstra, Cohen Children's Medical Center, East Garden City, New York. 15. Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Missouri-Kansas City and Children's Mercy Hospital, Kansas City, Missouri. 16. Kentucky Hospital Association, Louisville, Kentucky; and. 17. Divisions of Hematology, Oncology, and Blood and Marrow Transplant and Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio.
Abstract
BACKGROUND: A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites. METHODS: An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU. Outcome, process, and balancing measures were represented. Variables and statistical process control charts were mapped to each metric, elucidating progress over time and informing plan-do-study-act cycles. Electronic health record (EHR) abstraction feasibility was prioritized. Time 0 was defined as time of earliest sepsis recognition (determined electronically), or as a clinically derived time 0 (manually abstracted), identifying earliest physiologic onset of sepsis. RESULTS: Twenty-four evidence-based metrics reflected timely and appropriate interventions for a uniformly defined sepsis cohort. Metrics mapped to statistical process control charts with 44 final variables; 40 could be abstracted automatically from multiple EHRs. Variables, including high-risk conditions and bedside huddle time, were challenging to abstract (reported in <80% of encounters). Size or type of hospital, method of data abstraction, and previous QI collaboration participation did not influence hospitals' abilities to contribute data. To date, 90% of data have been submitted, representing 200 007 sepsis episodes. CONCLUSIONS: A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects in which researchers seek to leverage EHR data abstraction.
BACKGROUND: A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites. METHODS: An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU. Outcome, process, and balancing measures were represented. Variables and statistical process control charts were mapped to each metric, elucidating progress over time and informing plan-do-study-act cycles. Electronic health record (EHR) abstraction feasibility was prioritized. Time 0 was defined as time of earliest sepsis recognition (determined electronically), or as a clinically derived time 0 (manually abstracted), identifying earliest physiologic onset of sepsis. RESULTS: Twenty-four evidence-based metrics reflected timely and appropriate interventions for a uniformly defined sepsis cohort. Metrics mapped to statistical process control charts with 44 final variables; 40 could be abstracted automatically from multiple EHRs. Variables, including high-risk conditions and bedside huddle time, were challenging to abstract (reported in <80% of encounters). Size or type of hospital, method of data abstraction, and previous QI collaboration participation did not influence hospitals' abilities to contribute data. To date, 90% of data have been submitted, representing 200 007 sepsis episodes. CONCLUSIONS: A comprehensive data dictionary was developed for the largest pediatric sepsis QI collaborative, optimizing automation and ensuring sustainable reporting. These approaches can be used in other large-scale sepsis QI projects in which researchers seek to leverage EHR data abstraction.
Authors: Scott L Weiss; Mark J Peters; Waleed Alhazzani; Michael S D Agus; Heidi R Flori; David P Inwald; Simon Nadel; Luregn J Schlapbach; Robert C Tasker; Andrew C Argent; Joe Brierley; Joseph Carcillo; Enitan D Carrol; Christopher L Carroll; Ira M Cheifetz; Karen Choong; Jeffry J Cies; Andrea T Cruz; Daniele De Luca; Akash Deep; Saul N Faust; Claudio Flauzino De Oliveira; Mark W Hall; Paul Ishimine; Etienne Javouhey; Koen F M Joosten; Poonam Joshi; Oliver Karam; Martin C J Kneyber; Joris Lemson; Graeme MacLaren; Nilesh M Mehta; Morten Hylander Møller; Christopher J L Newth; Trung C Nguyen; Akira Nishisaki; Mark E Nunnally; Margaret M Parker; Raina M Paul; Adrienne G Randolph; Suchitra Ranjit; Lewis H Romer; Halden F Scott; Lyvonne N Tume; Judy T Verger; Eric A Williams; Joshua Wolf; Hector R Wong; Jerry J Zimmerman; Niranjan Kissoon; Pierre Tissieres Journal: Pediatr Crit Care Med Date: 2020-02 Impact factor: 3.624
Authors: Robert E Black; Simon Cousens; Hope L Johnson; Joy E Lawn; Igor Rudan; Diego G Bassani; Prabhat Jha; Harry Campbell; Christa Fischer Walker; Richard Cibulskis; Thomas Eisele; Li Liu; Colin Mathers Journal: Lancet Date: 2010-05-11 Impact factor: 79.321
Authors: Andrea T Cruz; Andrew M Perry; Eric A Williams; Jeanine M Graf; Elizabeth R Wuestner; Binita Patel Journal: Pediatrics Date: 2011-02-21 Impact factor: 7.124
Authors: Idris V R Evans; Gary S Phillips; Elizabeth R Alpern; Derek C Angus; Marcus E Friedrich; Niranjan Kissoon; Stanley Lemeshow; Mitchell M Levy; Margaret M Parker; Kathleen M Terry; R Scott Watson; Scott L Weiss; Jerry Zimmerman; Christopher W Seymour Journal: JAMA Date: 2018-07-24 Impact factor: 56.272
Authors: Raina Paul; Elliot Melendez; Anne Stack; Andrew Capraro; Michael Monuteaux; Mark I Neuman Journal: Pediatrics Date: 2014-04-07 Impact factor: 7.124
Authors: Halden F Scott; Richard J Brilli; Raina Paul; Charles G Macias; Matthew Niedner; Holly Depinet; Troy Richardson; Ruth Riggs; Heidi Gruhler; Gitte Y Larsen; W Charles Huskins; Fran Balamuth Journal: Crit Care Med Date: 2020-10 Impact factor: 9.296
Authors: Nynke A Kampstra; Nina Zipfel; Paul B van der Nat; Gert P Westert; Philip J van der Wees; A Stef Groenewoud Journal: BMC Health Serv Res Date: 2018-12-29 Impact factor: 2.655
Authors: Halden F Scott; Allison Kempe; Lalit Bajaj; Daniel M Lindberg; Ashley Dafoe; Brooke Dorsey Holliman Journal: Ann Emerg Med Date: 2022-07-13 Impact factor: 6.762