Patient and economic impact of implementing a paediatric sepsis pathway in emergency departments in Queensland, Australia
Robin Blythe, Paula Lister, Robert Seaton, Amanda Harley, Luregn J. Schlapbach, Steven McPhail, Balasubramanian Venkatesh, Adam Irwin, Sainath Raman, the Queensland State-wide Sepsis Collaborative, Luregn J. Schlapbach, Amanda Harley, Adam Irwin, Nicolette Graham, F. G. Thomson, Kieran Owen, Kirsten Garrish, Emma Sampson, Debbie Long, Shane George, Keith Grimwood, Christa Bell, Bethany Semple, Claire Adams, Josea Brown, Louise Maloney, Paula Lister, Scott Schofield, Clare Thomas, Liam Dejong, Esther Bently, Lambros Halkidis, Cheryl Bird, Matthew Smith, Pia Alexander, Laura Davidson-West, Titiosibina Ebenezer Adegbija, Alice Brandt, B.J. Walker, Andrea McLucas, Adam Philip Michael, Samantha Hoole, C. Bauer, J. D. Sutherland, Douglas Gordon Thomas, David Van der Walt, Jessica Hulme, Kerrie Burke, Helena Cooney, Doug Morel, Louise O’Riordan, Samantha Fairless, Megan Bool, Nandini Choudary, Shalini Arora, Ben Lawton, Jo Farrell, P.R.L.N. Prasad, Rudesh Prasad, Laura O’Connor, Timothy Butters, Peter W. Kennedy, Hanh M Pham, Maya Aoude, Sara Blundell, Natasha Willmett, Louise McGrath, Karen Smith, Kate Weller, Trina Maturanec, Michael J. Rice, Balasubramanian Venkatesh, Paul Lane, Robert Seaton, Donna Mason, Naitik Mehta, Vikrant R Kalke, Damien Jones, Mathew Sheldon Ames, Mary Steele, Amy Wilkinson, Kristen Gibbons, Patricia Gilholm, Endrias Ergetu, Rachel Treadwell, Tahlia Van Raders, Jessicah Minogue
Abstract
We examined systems-level costs before and after the implementation of an emergency department paediatric sepsis screening, recognition and treatment pathway. Aggregated hospital admissions for all children aged < 18y with a diagnosis code of sepsis upon admission in Queensland, Australia were compared for 16 participating and 32 non-participating hospitals before and after pathway implementation. Monte Carlo simulation was used to generate uncertainty intervals. Policy impacts were estimated using difference-in-difference analysis comparing observed and expected results. We compared 1055 patient episodes before (77.6% in-pathway) and 1504 after (80.5% in-pathway) implementation. Reductions were likely for non-intensive length of stay (- 20.8 h [- 36.1, - 8.0]) but not intensive care (-9.4 h [- 24.4, 5.0]). Non-pathway utilisation was likely unchanged for interhospital transfers (+ 3.2% [- 5.0%, 11.4%]), non-intensive (- 4.5 h [- 19.0, 9.8]) and intensive (+ 7.7 h, [- 20.9, 37.7]) care length of stay. After difference-in-difference adjustment, estimated savings were 596 [277, 942] non-intensive and 172 [148, 222] intensive care days. The program was cost-saving in 63.4% of simulations, with a mean value of $97,019 [- $857,273, $1,654,925] over 24 months. A paediatric sepsis pathway in Queensland emergency departments was associated with potential reductions in hospital utilisation and costs.