Pediatric Sepsis CoLab Updates
Grand Challenges Canada – Smart Triage Partnership
Congratulations to Drs. Tex Kissoon, Mark Ansermino, Sam Akech, Abner Tagoola and Nathan Kenya for their digital platform in rapidly triaging critically ill children in Uganda and Kenya! Smart Triage is one of 107 projects that have won funding through Grand Challenges Transition To Scale program. This program uses funding from the government of Canada to support innovators from Canada and low- and middle-income countries who are positioned to take their bold ideas to big impact in the area of global health.
Smart Triage includes a mobile Triage app using predictive algorithms + low cost mobile enabled pulse oximeter + clinician dashboard + bluetooth enabled treatment tracking system. The digital platform will facilitate data-driven and evidence-based improvements to the quality of care. It will also enable health care workers to recognize the most urgent children more rapidly, especially those presenting with sepsis, and allocate existing resources more efficiently. This project is implemented with partners including the University of British Columbia, CICH, Walimu in Uganda, and the Kenya Medical Research Institute and will be initially implemented at 6 hospitals in Uganda and Kenya.
Learn more about the Smart Triage here
The Pediatric Sepsis Data CoLab Dataverse
The Pediatric Sepsis Data CoLab Dataverse has been published and currently holds 2 dataverses and 2 datasets, relating to standardization of pediatric sepsis predictors and the environmental scan tools. Anyone interested can check out what has been published through this link.
Cameroon Association of Critical Care Nurses (CACCN) & Sepsis CoLab Partnership
Throughout 2019, the Sepsis CoLab has been working with the Cameroon Association of Critical Care Nurses (CACCN) to identify areas for partnership and quality improvement.
The CACCN is a professional organization dedicated to promoting optimal nursing care to the critically ill patients using available resources. CACCN aims to do this through enhancing continuous education and research, collaboration with health and health-related sectors, enhancement of certification standards, promote organization and mobilization of available resources, enhancement of clinical practice and professional development.
In July, the CACCN began collecting data for the Environmental Scan at four hospitals across Bamenda, Cameroon. The Scan is a tool developed by the Centre for International Child Health, to assess a facility’s readiness to manage pediatric sepsis.
The Scan focuses on critically ill children under 5 years of age. The leading causes of mortality in this age group are pneumonia, diarrhea, and malaria, all of which lead to the final pathway of sepsis before death. It is of paramount importance to determine whether a hospital at the district level is readily prepared to recognize these sick children and have the resources available to treat this population.
With over 11 sections and 27 pages, the Scan will take a few weeks to finish. Once completed, the data collected will provide a strong foundation for analysis of current hospital procedures and resources available to manage pediatric sepsis. With this information, the CoLab will work with CACCN to identify areas for quality improvement within the four hospitals in Cameroon.
A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria published in the Frontiers of Pediatrics in June 2019
ORIGINAL RESEARCH
published: 11 June 2019
doi: 10.3389/fped.2019.00234
The survey method was an online survey of tertiary pediatric hospitals in Nigeria using a modified survey tool designed by the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) executed by the Sepsis CoLab. The survey addressed all aspects of pediatric sepsis identification, management, barriers and readiness.
The PocketDoc (triage app and dashboard) update
The PocketDoc (triage app and dashboard) has reduced triage time in a pilot study in Uganda. The study is being conducted at the Holy Innocents Children’s Hospital in Uganda. Baseline data was collected between July to October 2018 with launch of intervention in October 2018.
Since the launch there has been a consistent reduction in time to first treatment. We have seen a reduction in the average time for children to receive their first intravenous antibiotic treatment from 1.5 to 1 hour and from 1.6 hours to 1.1 hours to receive their first intravenous fluid treatment. More notably, during the week of January 7-13 2019, it took on average only 53 minutes for children to receive their first intravenous antibiotic treatment. This is an incredible reduction in time to treatment, which has an overall positive impact on care for children.
The Sepsis CoLab, through the Centre for International Child Health (CICH) at BC Children’s Hospital with the support from the BC Children’s Hospital Foundation and Google Impact Challenge developed PocketDoc as a quality improvement project to improve triage practices. The triage app collects patient history and vital signs at triage and determines a risk admission for each patient. To further improve the current risk prediction variables, we undertook a modified Delphi process to build consensus on clinical signs, symptoms and vital signs that identified children at risk of sepsis at the time of presentation to the hospital. The process has recently been published. Read more here.
Launch of the PocketDoc and Dashboard Bundle
Through the Sepsis CoLab, the Centre for International Child Health (CICH) at BC Children’s Hospital with the support from the BC Children’s Hospital Foundation and Google Impact Challenge developed a mobile application and dashboard for the triage of children presenting to health care facilities in low resource settings. CICH partnered with Holy Innocents Children’s Hospital (HICH) in Mbarara, Uganda, to clinically evaluate the technology to improve prioritization of the care of children.
During the baseline evaluation over a three month period, 4,163 patients registered at the OPD, of which 409 received intravenous antibiotics, 235 received intravenous fluids, 47 received oxygen and 134 received nebulization. The baseline data showed it took on average 1.5 hours for children to receive their first intravenous antibiotic treatment and on average 1.6 hours to receive their first intravenous fluid treatment.
The PocketDoc and Dashboard bundle was successfully launched in October 2018. This novel technology collects patient information at triage and determines a risk score for each patient. The risk score prioritizes patients in the Dashboard in real time. Clinicians are then able to determine who to see and who to treat immediately.
Nurses and clinicians from HICH immediately said the technology improved patient interaction, improved the health workers ability to quickly treat sick patients, and improved communication among all hospital staff. This new technology has the ability to identify those children who are suffering from serious illness or infection and decrease the time to first treatment. In collaboration with hospital staff, we will continue to use these tools to improve the quality of care for children. More results of the impact of the intervention will be available in early 2019.
The Digital Environmental Scan: Ready to use
The environmental scan is a tool that assesses a health facility’s processes, procedures, and capacity to respond to the demands of paediatric sepsis. This will lead to a better understanding of the safety, quality, and efficiency of care. We are looking for healthcare professionals to test this tool at their health facility.