Sepsis Simulation: Hillsborough ED to UNC Children's PICU

The occurrence of pediatric sepsis has been steadily rising since the mid-1990s. It now accounts for 4.4 percent of admissions to children's hospitals nationally and 7 percent of patients treated in the PICUs in the United States. UNC is addressing this issue with new protocols. Recently, the Code Sepsis team held a mock sepsis event, using a standardized pediatric patient, with the Hillsborough Hospital Emergency Department and the PICU at UNC Children's.

Sepsis Simulation: Hillsborough ED to UNC Children's PICU click to enlarge Declan presents with sepsis in the Hillsborough ED.
Sepsis Simulation: Hillsborough ED to UNC Children's PICU click to enlarge The Hillsborough team evaluates protocols for cases of pediatric sepsis.

As the Code Sepsis team continues to implement the UNC Medical Center sepsis reduction initiative, it is using innovative simulation to test readiness.

Recently, a standardized patient -- a seven-year-old male named Declan, the son of Dr. Tina Schade Willis, Associate Chief Medical Officer for Quality at UNC Hospitals, a physician in the Pediatric Intensive Care Unit, and Code Sepsis lead - presented at the Hillsborough Hospital Emergency Department, where the Code Sepsis team and on-site health-care personnel tested protocols and transferred him to the North Carolina Children's Hospital Pediatric Intensive Care Unit (PICU).

Declan presented via Orange County EMS for evaluation of fever and lethargy. He was determined to have septic shock from meningococcemia and was treated with normal saline boluses, antibiotics, and vasopressors, but he quickly decompensated and required intubation.

After stablization, he was transported to the North Carolina Children's Hospital PICU via Carolina Air Care. WebEx and FaceTime technologies were used to follow the patient's course. The mock event tested the capabilities and response of UNC Medical Center to the type of case that is steadily rising.

Read takeaways from those involved in the simulation:

"The team members were very open to the concept of simulation. They had a great attitude and contributed to improving our recognition and response to sepsis. These exercises are invaluable in finding areas of needed improvement and practicing teamwork." --Dr. Tina Schade Willis 

"The session helped us evaluate previous adjustments to system operations and individual communication techniques as well as identify new areas for the team to concentrate on in improving patient care. The use of a standardized patient for this simulation allowed us to apply the TeamSTEPPS concepts and truly evaluate the communication that occurs from the bedside to the ICU." --Gene Hobbs, Associate Director of Simulation, Clinical Skills and Patient Simulation Center

"Seeing my own child, even in a simulated 'practice' sepsis case, was a new experience. It brought reality to the helpless and scared feelings parents have when their child has sepsis. It also allowed for the team members to see a real child instead of a simulation mannequin, which brought the patient-centered approach to the forefront. When children are our patients, their entire families become patients too." --Dr. Tina Schade Willis

Filed under: