56 - Intervention Mapping for Adaptation (IM-Adapt) Implementation Workgroups to Improve Sepsis Diagnosis in Children in General Emergency Departments: The Right Call

Publication Number: 3053.56

Christina Studts, University of Colorado School of Medicine, Aurora, CO, United States; Ashley C. Dafoe, University of Colorado School of Medicine, Thornton, CO, United States; Alison Saville, University of Colorado School of Medicine, Denver, CO, United States; Caroline I. Tietbohl, University of Colorado Anschutz, Aurora, CO, United States; Joseph A. Grubenhoff, University of Colorado School of Medicine, AURORA, CO, United States; Daniel M. Lindberg, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Halden F. Scott, University of Colorado School of Medicine, Denver, CO, United States

Background: Timely sepsis diagnosis improves outcomes. Accurate, timely diagnosis of sepsis in children is less likely in general Emergency Departments (EDs), where ~80% of children are treated. Existing children's hospitals' transfer call systems provide real-time pediatric emergency care advice to referring general EDs treating children. Based on effective sepsis diagnosis tools currently in use in children's hospitals, we applied the IM-Adapt process to extend their reach through transfer processes to pediatric patients in general EDs.

Objective: To co-develop a diagnostic safety toolkit for pediatric sepsis to be integrated within existing transfer call workflows

Design/Methods: The IM-Adapt Workgroup (N=11 plus research team) was composed of transfer center nurses, executive sponsors, a referring physician, accepting physicians who receive transfer calls, and members of the hospital sepsis QI team [Table 1]. Four monthly 90-minute structured Workgroup Meetings were held, each addressing: (1) Summary of findings, (2) brief group reflections, and (3) discussion/decisions on next actionable topic. Data developed and presented at meetings included qualitative interviews with referring providers, conversation analysis of transfer calls, quantitative analysis of current sepsis diagnosis in transfer patients. Members completed an online survey after each meeting providing anonymous feedback on preliminary decisions reached (importance and feasibility ratings, comments) [Table 2].

Results: Facilitated meetings and novel data elicited high levels of participation and >90% attendance. Sharing disparate ratings/comments from post-meeting surveys resulted in group-driven adjustments to decisions [Table 2]. The final toolkit and implementation plan included roles and tools for transfer center nurses; referring/accepting physicians; and dissemination of referring and accepting physician resources through existing channels [Figure 1].

Conclusion(s): Children's hospitals' transfer call centers are a replicable resource to disseminate crucial, timely pediatric knowledge to general EDs. Our approach to structured IM-Adapt Workgroups yielded actionable insights in a short timeframe, resulting in content-specific tools and work system improvements to the transfer call process. Assessment of adoption will be ongoing, and implementation and effectiveness outcomes will be assessed after two years of implementation.

Table 1. IM-Adapt participants


Table 2. Meeting content and decisions


Figure 1. Accepting physician and transfer nurse work tool produced through IM-Adapt process. Similar modified versions produced for badgecards, and for referring providers.