I can’t describe what it feels like to be talking with a child one moment and in a matter of hours watch as their organs shut down one by one. It’s impossible to convey the agony of telling a family their child didn’t recover from what they thought was a cold, or the heart wrench when they survive but suffer lifelong disability.
This is the devastation of sepsis, a chameleon condition hiding behind common symptoms as the immune system attacks its own body. It occurs in response to an infection of any kind. It can happen to anyone, anytime, anywhere.
A couple of decades ago we knew little about this mysterious threat. Hospitals were not screening for it, and the condition was only recognized after organs began failing. Most physicians didn’t even say the word “sepsis” in their emergency departments where it was likely occurring all the time. Everyone had their own definitions of sepsis, which changed frequently. Sepsis preparedness was almost totally absent from the culture of care.
Today, we have more standardized definitions, more effective screenings, and a culture of early recognition. In the emergency department at Primary Children’s Hospital where I work, our systems alert us to sepsis risks and nurses are trained to pull together staff for a huddle if they suspect sepsis in a patient. When that happens, kids get treatment faster, which saves lives and prevents disability.
We got here through years of improvement work, including collaboration among a handful of pioneering children’s hospitals culminating in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative that involved 66 diverse hospitals across the country. These efforts gave us a shared language and made sepsis OK to say in medical care. That means we now recognize it earlier and treat it quicker — and more children survive.
We still have a long way to go. Worldwide, more than 3 million kids die from sepsis every year, including 7,000 in the U.S. Many who survive face debilitating health issues.
Sepsis is a persistent challenge for many reasons. It’s impossible to predict when an infection will develop into sepsis. Once it does, it looks like many other illnesses in the early stages, and symptoms vary widely from child to child. Identifying nuanced symptoms such as “altered mental status”— associated with a higher likelihood of dying from sepsis — can be difficult even for those of us who primarily care for children. Imagine how difficult that must be for a general ED practitioner who may see a pediatric patient once or twice per day, if at all.
To make a significant difference in sepsis moralities in the U.S. and abroad, hospitals of all types need specific and standard ways to recognize and treat sepsis based on validated evidence. Developing that requires large, robust data sets of diverse populations from hospital sites that can implement, test, and measure strategies over time.
That’s why the IPSO collaborative was so important. It allowed nearly 70 different hospital systems to report standardized data from more than 100,000 sepsis episodes and spend eight years fine-tuning and validating specific tools and strategies. Among other results, it developed a care bundle associated with 50% lower mortality in children with critical sepsis and 80% lower mortality in children with suspected sepsis.
Improving outcomes everywhere
The collaborative has compiled its tools and strategies into a how-to manual for pediatric sepsis care called a change package. It provides a roadmap that can give kids a much better chance of survival.
In the U.S., the majority of pediatric patients are treated in general care hospitals by providers who do not specialize in treating kids. All hospitals — whether general or pediatric, big or small, rural or urban, domestic or international — can use the change package and start saving lives no matter where they are in their sepsis journey.
The IPSO bundle is replicable, scalable, and reliable. At Intermountain Health, we’ve taken the lifesaving bundle from one emergency department and implemented it throughout the system, including more than 30 EDs.
Wouldn't it be great if we could get sepsis mortality to single digits — and ultimately to zero? This change package equips providers to do that in the most concrete way possible, better than anything else that's been put out there.
By sharing these evidence-based strategies with hospitals around the world, we can improve sepsis outcomes for children everywhere.
Dr. Lane is a co-author of the Improving Pediatric Sepsis Outcomes Change Package.
