On World Sepsis Day, Michigan Medicine celebrates ‘tiny’ successes
Earlier this year, a pediatric patient was brought to the emergency department (ED) at C.S. Mott Children’s Hospital by her parents because she had been experiencing multiple symptoms following a recent procedure for a small bowel obstruction. Her symptoms included decreased activity and oxygen levels as well as fever.
A team in the ED evaluated the patient and diagnosed her with pneumonia and an upper respiratory infection. She was placed on oxygen, given fluids and a dose of Tylenol and admitted for further observation.
When she was admitted, her vital signs and symptoms triggered an immediate — and novel — chain of events at Michigan Medicine.
Sepsis Response Team
Sepsis, which is a potentially life-threatening condition that occurs when a body’s response to infection goes into overdrive and triggers a chain reaction that may injure other tissues and organs, is the third most frequently coded diagnosis at Michigan Medicine. Research suggests that nearly 7,000 children die from severe sepsis each year across the U.S.
As part of the organization’s effort to improve identification and treatment of the condition, Mott created the Sepsis Response Team (SRT) in April 2018. The team is comprised of multiple care providers, including nursing and at least one physician.
“The SRT is designed to respond when patients show specific symptoms or vital signs that may indicate the presence of sepsis, as it did for this particular patient,” said Kimberly Monroe, M.D., an assistant professor of pediatrics who is part of the Improving Pediatric Sepsis Outcomes team at Mott.
In fact, this patient was one of the first to benefit from the SRT response when the changes were adopted in the ED — and it may have saved her life.
“Without the ability to identify and treat sepsis as rapidly as we did in this case, the patient may have ended up in the intensive care unit,” said Monroe. “We are thrilled that the improvements we made have proven to lead to better screening, evaluation and treatment for potential sepsis patients.”
Putting practices into motion
So what were these improvements?
First, the team developed a trigger tool that runs automatically in the background of the electronic medical chart. If the patient shows concerning vital signs, the nurse is flagged to complete a secondary screen. Depending on the severity of the secondary screen score, an SRT is called.
The multidisciplinary SRT meets with the patient and makes a collaborative assessment of her/his condition. This may lead to timely prescription of medications, fluids and other treatments dependent on the patient’s unique signs and symptoms.
“We recognize that each patient is different and each individual’s symptoms are different, which makes sepsis difficult to diagnose,” Monroe said. “In order to ensure that the patient’s medications were effective and her condition was improving, we made repeated assessments of her symptoms.”
Within three days of treatment, the patient was well enough to be discharged home with only oral antibiotics.
“This case highlighted practices that can improve sepsis care, including collaborative assessment and decision making, recognition of the different sepsis severities and the importance of repeat assessments,” Monroe said. “By putting all those into motion, we were able to keep our patient out of the intensive care and get her back home as quickly and safely as possible.”
On World Sepsis Day, it is important to celebrate successes like this that make the work of the Improving Pediatric Sepsis Outcomes committee — and faculty and staff across the organization — worth it.
“Sepsis is a difficult condition to identify and treat, but teams across Michigan Medicine are working daily to improve care for septic patients,” Monroe said. “We’re just happy to be able to celebrate that success.”
Researchers at Michigan Medicine recently released a study on the costs of pediatric sepsis, which is posted on the U-M Health Lab blog.