PROJECT SUMMARY/ABSTRACT
Sepsis affects >70,000 U.S. children annually with 5-10% mortality, 35% long-term morbidity, and annual
national costs of $7.3 billion. Outcomes are improved by timely diagnosis, which is less likely in general
Emergency Departments (EDs) which treat adults and children. Although up to 80% of children with sepsis are
treated in general EDs, the few studies in these settings have not identified strategies to improve diagnosis.
Sepsis is an exemplar condition for challenges to timely diagnosis, highlighting diagnostic complexities noted in
the National Academies of Sciences, Engineering, and Medicine’s 2015 report Improving Diagnosis in Health
Care. This project also addresses challenges in pediatric emergency preparedness noted in the Institute of
Medicine’s 2007 report, Growing Pains. The long-term goals of this work are to identify strategies to improve
diagnosis of high-risk conditions in EDs. While establishing capacity to improve diagnosis across emergency
conditions, the initial demonstration project will focus on pediatric sepsis, using methods of 1) identification,
analysis, and reduction of diagnostic errors, and 2) work system improvements. It will uniquely leverage the
transfer call center and the brief consultative phone call as an opportunity to apply diagnostic safety strategies
and disseminate pediatric subspecialty knowledge. Phone calls with consultants are frequently used in
diagnostic decision-making in EDs and have rarely been studied; this team will apply conversation analysis to
recorded calls to identify opportunities to improve communication and the diagnostic process. This study will
adapt and implement a diagnostic safety toolkit including: 1) a content-specific sepsis diagnostic checklist with
demonstrated effectiveness in pediatric EDs, 2) improvement in subspecialty consultation processes to follow
diagnostic safety principles. The study will be conducted in a children’s hospital transfer call center that
receives calls about >18,000 children in >100 general EDs yearly. The aims are: SA1: Analyze the current
diagnostic process in children with sepsis referred to the transfer center using mixed methods. Conversation
analysis of recorded phone calls and quantitative analysis will guide evaluation of diagnostic accuracy and the
diagnostic work system and process. SA2: Use the Implementation Mapping Adapt process to adapt diagnostic
strategies (content-specific checklist and work system improvements) for implementation in the transfer center
call process. SA3: Implement and evaluate the sepsis diagnostic safety toolkit in an 18-month implementation
study. This work will establish strategies for improving the diagnosis of time-sensitive pediatric emergencies in
general ED settings, where most children receive their critical first hours of treatment. Children’s hospitals’
transfer call centers are a unique, replicable opportunity to disseminate pediatric knowledge at the moment it is
needed, improving diagnostic safety for children in any ED. Strategies identified in this work focused on
content-specific checklists and work system improvements to the phone consultation process can be replicated
in other conditions, improving diagnosis and safety in emergency medicine.
