Effect of a Sepsis Educational Intervention on Hospital Stay

Objectives: To evaluate adherence to the sepsis bundle before and after an educational strategy and its impact on hospital stay. Design: A prospective, analytic, before-and-after study of children with severe sepsis and septic shock who presented to the emergency department. Setting: Carried out from January to December 2014 in the emergency department of a quaternary care hospital. Patients: Of a total of 19,836 children who presented to the emergency department, 4,383 had an infectious pathology, with 203 of these showing severe sepsis and septic shock (124 pre intervention, and 79 post intervention). Interventions: The healthcare providers caring for the patients in pediatric emergency received an educational intervention and an update on the bundle concepts proposed in 2010 by the Pediatric Advanced Life Support program of the American Heart Association and adapted by this study’s investigators. Measurements and Main Results: The main cause of sepsis in both groups was respiratory (59 vs 33; p = 0.72), without differences in the Pediatric Index of Mortality 2 score (7.23 vs 8.1; p = 0.23). The postintervention group showed a reduced hospital stay (11.6 vs 7.9 d; p = 0.01), a shorter time before ordering fluid boluses (247 vs 5 min; p = 0.001), the application of the first dose of antibiotic (343 vs 271 min; p = 0.03), and a decreased need for mechanical ventilation (20.1% vs 7.5%; p = 0.01). Postintervention adherence to the complete bundle was 19.2%, compared with the preintervention group, which was 27.7% (p = 0.17). Conclusions: Adherence to a bundle strategy is low following an educational intervention. However, when patients are managed after instruction in guideline recommendations, hospital stay may be significantly reduced. Drs. Fernández-Sarmiento, Salinas, and Galvis conceived the study and its design. Drs. Salinas and Galvis carried out the educational intervention of concept reinforcement and updating, as well as the evaluation of each of the participants. Drs. Salinas, Galvis, and López collected the data of the patients included in the study, applied the Pediatric Index of Mortality 2 score to each patient, and tabulated the data. Dr. Fernández-Sarmiento and Carcillo supervised the study implementation and the data collected. Dr. Jagua provided statistical advice on study design, analyzed the data, and prepared graphics. All the authors drafted the article and contributed significantly to the article revision. All authors approved the final article as submitted and agree to be accountable for all aspects of the work. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: JaimeFe@unisabana.edu.co ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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