As an ICU physician and deputy quality and safety officer, Sarah Kandil, MD, has seen the transformative impact of pediatric sepsis recognition and treatment.
At Yale New Haven Children’s Hospital, Dr. Kandil has witnessed how strategies from the Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes (IPSO) collaborative have changed how teams respond to potential sepsis cases on general floors and improved patient outcomes.
For eight years, Dr. Kandil led research within the IPSO collaborative of 66 children’s hospitals across the country. She co-authored the recently published IPSO change package and serves as vice chair for the association’s Sepsis Community of Practice.
Children’s Hospital Association (CHA) asked Dr. Kandil about her involvement with sepsis efforts and the importance of the change package.
What is the IPSO collaborative and why did you join?
It was a national quality improvement collaborative led by CHA to reduce sepsis-related morbidity and mortality in children. We recognized the critical need for standardized, timely sepsis care. CHA emphasized the importance of early recognition and treatment for sepsis, and having a large community of children’s hospitals created a power of shared learning. Working together as a group accelerated our improvement efforts and gave us access to data and best practices we wouldn’t have had otherwise.
What was the state of sepsis care before the collaborative, and where is it now?
Before, sepsis care was often fragmented and could vary across hospitals and different institutions. Many hospitals didn’t have standardized screening or escalation processes, so kids were being recognized late or not treated quickly enough when they presented with sepsis.
Now, we’re seeing a much more proactive and reliable approach for sepsis care — structured screening tools, defined care pathways, real-time data, and clearer roles in the sepsis response. It’s really made care safer, faster, and more consistent for children.
What is the change package, and why did you create it?
The change package is our way of capturing all of the progress and learning from the IPSO collaborative. It’s basically a roadmap — whether you’re just starting a sepsis initiative or trying to sustain one within your institution, the resource helps guide the work in a very structured and proven way.
One of the most impactful concepts from the change package is bundle-based care. Data showed that even if you hit a single metric, the outcomes weren’t as good. However, if multiple things were done together as a bundle, it resulted in better outcomes.
How has being a part of this work made a difference in your hospital and your pediatric health care journey?
For me, being part of this work and being able to share the learnings has really been transformative in that everyone now is speaking the same language and talking about sepsis more regularly.
During bedside huddles, whether a child may or may not have sepsis becomes part of the conversation. It’s no longer a negative thing to ask if a patient has sepsis. Today, we ask ‘What can we do sooner to try and address it?’
We’ve also changed how we respond to potential sepsis cases on general floors. Our teams developed reliable screening tools, escalation pathways, and clear roles. As a result, patients get antibiotics and fluids faster, leading to improved outcomes such as less hospital-onset sepsis as well as fewer transfers to the ICU. The IPSO learning really gave us some structure to make these changes.
How do you hope hospitals use the change package?
I hope the change package empowers teams to take action. It is based on real-world experiences and outcomes from a set of tested ideas and approaches that different hospitals used when they’ve implemented sepsis bundles.
It’s not a checklist; it is a flexible guide. If you’re just building a program or refining one, it helps teams align and accelerate progress. It can support where you are in your sepsis journey, identify gaps, and then guide you on how to move forward.
What’s next for sepsis quality improvement now that the collaborative concluded and the change package is published?
Right now, the focus is on sustaining the gains and spreading what we know worked. The Sepsis Community of Practice continues this work as we share the change package with hospitals and offer learning webinars.
But there’s still a lot of opportunity to really understand sepsis and outcomes. Whether reducing outcome disparities among specific populations, figuring out more sophisticated ways to use the data, looking at pre-hospital episodes, or targeting high-risk populations — sepsis improvement will always be ongoing. We are just moving into the next phase of sustaining the momentum.
