CHRISTUS Children’s Westover Hills Free Standing Emergency Department

San Antonio, Texas

The shared governance model at the 12-bed CHRISTUS Children’s Westover Hills Free Standing Emergency Department empowered emergency nurses to participate and adjust the pediatric sepsis pathway to meet the one-hour bundle. A thorough review of patients diagnosed with severe sepsis identified opportunities for improvement. A study of evidence-based literature identified a variety of parameters utilized to trigger sepsis alerts and the specific values assigned to each parameter. Specific changes were made to the ED assessment tool to improve the specificity and more accurately identify those critical sepsis patients in the early stages. The ED Unit-Based Council made a request to create a nurse-initiated sepsis alert. Nurses were empowered to identify and implement a sepsis alert based on clinical nursing judgement.

Chart audits indicated that the largest number of fallouts was in the neonatal group, which was caused by the amount of time the provider needed to obtain a lumbar puncture. The ED leadership team reviewed the literature and adjusted the sepsis algorithm to allow for IM antibiotics to be given to this select population. This change to the sepsis protocol produced a significant decrease in time to antibiotics from May 2023 through December 2023, despite the winter surge.