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What is already known on this topic Guidelines for the initial management of paediatric sepsis have not been widely incorporated into standard practice.
Sepsis quality improvement initiatives improve adherence to sepsis guidelines.
The effect of quality improvement initiatives on patient-centred outcomes remains unclear.
What this study adds Quality improvement initiatives targeting paediatric sepsis are associated with reduced hospital length of stay.
Larger studies are required to assess the effect on mortality.
Introduction
Paediatric sepsis resuscitation has been informed by several published guidelines. 1 2 Despite the lack of high-quality evidence, these guidelines are the framework for Pediatric Advanced Life Support and Advanced Paediatric Life Support courses. Additionally, though no feasibility data exist, their time-based interventions constitute a standard of care upon which practice is benchmarked. Compliance with these guidelines has been poor, with 19% of patients in paediatric emergency departments (EDs) 3 and 38% in paediatric intensive care units (ICUs) 4 receiving care that complied with the guidelines. As a result, their impact on patient outcomes is uncertain. Nevertheless, quality improvement (QI) strategies aimed at improving compliance with these guidelines have been studied in the paediatric ED and have resulted in improved process and outcome measures. 5-7
Over a decade ago, a landmark randomised controlled trial of protocolised sepsis care in adults demonstrated improved survival in patients receiving early goal-directed therapy (EGDT). 8 EGDT became incorporated into standard care through the bundled approach advocated by the Surviving Sepsis Campaign (SSC) 2 and by standards endorsed by the National Quality Forum. It remained unclear, however, which specific components of EGDT were responsible for any observed survival advantage. Subsequently, in large multicentred randomised trials, EGDT has not been shown to confer any survival advantage compared with current standard care. 9-12 The incorporation of early identification, early antibiotic administration and judicious targeted fluid resuscitation into standard care is thought to be responsible for the majority of this lack of observed benefit from further protocolisation in adults. 13-15 If these basic interventions are given in a timely manner, adding other interventions in a protocol may make minimal difference. 14 It is unclear whether these findings are generalisable to paediatric sepsis management, where EGDT and protocolisation have never been evaluated in a prospective or randomised fashion.
We aimed to prospectively...