Implementing a screening algorithm for early recognition of sepsis in hospitalized children: a quality improvement project

Yael Feinstein, Slava Kogan, Jacob Dreiher, Ayelet Noham, Shimrat Harosh, Jenia Lecht, Tzipi Sror, Nurit Cohen, Eileen Bar-Yosef, Eli Hershkowitz, Isaac Lazar, Yochai Schonmann, David Greenberg, Dana Danino

Research output: Contribution to journalArticlepeer-review


Sepsis is a leading cause of mortality in children. Utilizing a screening tool for early recognition of sepsis is recommended. Our centre had no screening tool for sepsis nor a standardized protocol for sepsis management. In December 2020, a screening algorithm for sepsis was implemented. The algorithm consisted of vital signs measurements in children with an abnormal body temperature, a pop-up alert, nurse's and physician's evaluation, and activation of a workup protocol. The project's primary aim was to increase vital signs measurement rates in hospitalized children with abnormal body temperature from 40% to >90% within 6 months, by 1 June 2021, and sustain until 31 December 2021. Adherence to the algorithm and performance were monitored during 2021, and the outcomes were compared to the preceding 5 years and a control ward. The alert identified 324 children and 596 febrile episodes. Vital signs measurement adherence increased from 42.7% to >90% in 2 months. A nurse evaluated 86.4% of episodes, and a physician evaluated 83.0% of these. Paediatric intensive care unit (PICU) admission rates were lower in the intervention period vs. the pre-intervention period vs. the control ward (4.6% vs. 5.6% vs. 6.0%, respectively); the median PICU length of stay was shorter in the intervention vs. the control ward [2.0 (IQR 1, 4) vs. 5.5 (IQR 2, 7), respectively]. These differences were not statistically significant. During the intervention period, the adherence to vital signs measurements reached the goal of >90%. The alert system prompted an evaluation by caregivers and management according to the protocol. Further monitoring is needed to improve outcomes.

Original languageEnglish
Article numbermzad006
JournalInternational journal for quality in health care : journal of the International Society for Quality in Health Care
Issue number1
StatePublished - 30 Jan 2023


  • early recognition
  • hospitalized children
  • sepsis alert

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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