Improving Pediatric Sepsis Outcomes

Improving Pediatric Sepsis Outcomes

Change Package

Impact of sepsis on children

Every year, an estimated 24 million children develop sepsis worldwide. Nearly 3 million die (Rudd et al, 2020), and more than a third of those who survive experience significant long-term health issues, failing to return to their baseline health after a year (Ravikumar, 2022). Given the significant burden of this disease, its designation as an improvement priority area by The Joint Commission and the World Health Organization, and its impact on all domains of health care quality, pediatric sepsis is a vital area for quality improvement (QI).

Early recognition and prompt treatment of sepsis optimizes outcomes, according to care guidelines for pediatric patients (Weiss et al, 2020b; Davis et al, 2017). However, recognizing and treating sepsis in children poses a challenge due to the heterogenic presentation of multiple similar conditions (Emr et al, 2018). Additionally, sepsis has a different pathophysiology and clinical presentation in children than in adults and requires different therapeutic approaches. Finally, studies indicate that disparities exist in pediatric sepsis care related to social drivers of health (Phelps et al, 2023; Mitchel et al, 2021).


Improving outcomes

To address these issues and improve sepsis care for all children, Children’s Hospital Association (CHA) launched the Improving Pediatric Sepsis Outcomes (IPSO) collaborative. From 2016 to 2023, 66 children’s hospitals came together to reduce sepsis-attributable mortality using multimodal QI science, evidence-based bundles of care, and data-driven performance evaluation (Larsen et al, 2021). Leveraging data collected from over 100,000 pediatric sepsis episodes (based on IPSO’s intention-to-treat definition) in both emergency department (ED) and inpatient settings, IPSO created a change package to help hospitals develop, implement, and sustain high-quality pediatric sepsis programs.


Introduction to the change package

The change package summarizes the collaborative’s learnings and recommendations, including:

  • Optimal bundle of care, with implementation guidance for each key component
  • Performance measurement considerations
  • Guidance for sepsis program development
  • Library of tools designed and implemented by the IPSO collaborative hospitals

The change package is intended to guide teams in emergency rooms and inpatient hospital settings through the process of establishing a coordinated sepsis program. It should be used in conjunction with the latest pediatric sepsis literature, and teams should continue to consult with pediatric sepsis experts for real-time guidance when caring for patients.

We do not recommend implementing all interventions at once, and all options may not be relevant for a particular hospital or care setting. Instead, hospitals should start by assessing their current state, gaps, and opportunities. Each hospital will have a variety of experience levels, expertise, and existing practices related to pediatric sepsis care. The readiness inventory can help hospitals assess current state and consider opportunities to integrate IPSO recommendations with existing practices.

Authors

  • Elise Buckwalter, MSN, CPNP-AC
  • Holly Depinet, MD, MPH
  • Sarah Kandil, MD
  • Grant Keeney, MD, MS
  • Roni D. Lane, MD


Contributors

  • Mahsa Akhavan, MD
  • Elizabeth Mack, MD, MS
  • Monica Nielsen-Parker, MSW
  • Raina Paul, MD
  • Ruth Riggs
  • Melissa Schafer, MD
  • Erin M. Schulz, MSN, RN, EMT, C-NPT
  • Jayne Stuart, MPH
  • Jennifer Wilkes, MD, MSCE
  • Advocate Children’s Hospital
  • Akron Children’s Hospital
  • Ann & Robert H. Lurie Children’s Hospital of Chicago
  • Arkansas Children’s Hospital
  • Arnold Palmer Hospital for Children
  • Atrium Health Levine Children’s Hospital
  • Beacon Children’s Hospital
  • Boston Children’s Hospital
  • The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital
  • C.S. Mott Children’s Hospital
  • Children’s Health, Dallas
  • Children’s Healthcare of Atlanta
  • The Children’s Hospital at Saint Francis
  • Children’s Hospital Colorado
  • Children’s Hospital of Orange County
  • Children’s Hospital of Philadelphia
  • Children’s Hospital of Richmond at VCU
  • Children’s Memorial Hermann Hospital
  • Children’s Mercy Kansas City
  • Children’s National Hospital
  • Children’s Nebraska
  • Children’s of Alabama
  • Children’s Minnesota
  • Children’s Wisconsin
  • Cincinnati Children’s
  • Cohen Children’s Medical Center
  • Cone Health Women’s & Children’s Center at Moses Cone Hospital
  • Connecticut Children’s Medical Center
  • Cook Children’s Medical Center
  • Corewell Health Helen DeVos Children’s Hospital
  • Dell Children’s Medical Center
  • El Paso Children’s Hospital
  • Goryeb Children’s Hospital
  • Hasbro Children’s Hospital at Rhode Island Hospital
  • Hassenfeld Children’s Hospital at NYU Langone
  • Hoops Family Children’s Hospital
  • Inova L.J. Murphy Children’s Hospital
  • Janet Weis Children’s Hospital at Geisinger
  • Johns Hopkins All Children’s Hospital
  • Loma Linda University Children’s Hospital
  • Mary Bridge Children’s Hospital & Health Network
  • Mayo Clinic Children’s Center
  • MercyOne Children’s Hospital – Des Moines
  • Monroe Carell Jr. Children’s Hospital at Vanderbilt
  • MUSC Shawn Jenkins Children’s Hospital
  • Nationwide Children’s Hospital
  • Nemours Children’s Hospital, Delaware
  • Nemours Children’s Hospital, Florida
  • Nicklaus Children’s Hospital
  • Niswonger Children’s Hospital
  • North Carolina Children’s Hospital
  • Oklahoma Children’s Hospital OU Health
  • Penn State Children’s Hospital
  • Phoenix Children’s
  • Primary Children’s Hospital
  • Seattle Children’s
  • St. Jude Children’s Research Hospital
  • St. Luke’s Children’s Hospital St. Luke’s Regional Medical Center
  • Texas Children’s Hospital
  • UH Rainbow Babies & Children’s Hospital
  • University of Maryland Children’s Hospital
  • University of New Mexico Children’s Hospital
  • UPMC Children’s Hospital of Pittsburgh
  • Upstate Golisano Children’s Hospital
  • Valley Children’s Healthcare
  • Yale New Haven Children’s Hospital
  • Advocate Children’s Hospital
  • Akron Children’s Hospital
  • Ann & Robert H. Lurie Children’s Hospital of Chicago
  • Arkansas Children’s Hospital
  • Arnold Palmer Hospital for Children
  • Atrium Health Levine Children’s Hospital
  • Beacon Children’s Hospital
  • Boston Children’s Hospital
  • The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital
  • C.S. Mott Children’s Hospital
  • Children’s Health, Dallas
  • Children’s Healthcare of Atlanta
  • The Children’s Hospital at Saint Francis
  • Children’s Hospital Colorado
  • Children’s Hospital of Orange County
  • Children’s Hospital of Philadelphia
  • Children’s Hospital of Richmond at VCU
  • Children’s Memorial Hermann Hospital
  • Children’s Mercy Kansas City
  • Children’s National Hospital
  • Children’s Nebraska
  • Children’s of Alabama
  • Children’s Minnesota
  • Children’s Wisconsin
  • Cincinnati Children’s
  • Cohen Children’s Medical Center
  • Cone Health Women’s & Children’s Center at Moses Cone Hospital
  • Connecticut Children’s Medical Center
  • Cook Children’s Medical Center
  • Corewell Health Helen DeVos Children’s Hospital
  • Dell Children’s Medical Center
  • El Paso Children’s Hospital
  • Goryeb Children’s Hospital
  • Hasbro Children’s Hospital at Rhode Island Hospital
  • Hassenfeld Children’s Hospital at NYU Langone
  • Hoops Family Children’s Hospital
  • Inova L.J. Murphy Children’s Hospital
  • Janet Weis Children’s Hospital at Geisinger
  • Johns Hopkins All Children’s Hospital
  • Loma Linda University Children’s Hospital
  • Mary Bridge Children’s Hospital & Health Network
  • Mayo Clinic Children’s Center
  • MercyOne Children’s Hospital – Des Moines
  • Monroe Carell Jr. Children’s Hospital at Vanderbilt
  • MUSC Shawn Jenkins Children’s Hospital
  • Nationwide Children’s Hospital
  • Nemours Children’s Hospital, Delaware
  • Nemours Children’s Hospital, Florida
  • Nicklaus Children’s Hospital
  • Niswonger Children’s Hospital
  • North Carolina Children’s Hospital
  • Oklahoma Children’s Hospital OU Health
  • Penn State Children’s Hospital
  • Phoenix Children’s
  • Primary Children’s Hospital
  • Seattle Children’s
  • St. Jude Children’s Research Hospital
  • St. Luke’s Children’s Hospital St. Luke’s Regional Medical Center
  • Texas Children’s Hospital
  • UH Rainbow Babies & Children’s Hospital
  • University of Maryland Children’s Hospital
  • University of New Mexico Children’s Hospital
  • UPMC Children’s Hospital of Pittsburgh
  • Upstate Golisano Children’s Hospital
  • Valley Children’s Healthcare
  • Yale New Haven Children’s Hospital

Children’s Hospital Association. IPSO Change Package (1st ed.). Washington, DC. Children’s Hospital Association; 2025.

Download the Change Package

For more information, contact us at quality.programs@childrenshospitals.org.

Visit the Children’s Hospital Association website to learn more about CHA and the Improving Pediatric Sepsis Outcomes Collaborative.

For citations, see our references page. This change package was created in March 2025 by Children’s Hospital Association quality improvement consultants and Improving Pediatric Sepsis Outcomes thought leaders and reflects best evidence to date at the time of publication. Pediatric sepsis evidence is always evolving, and readers should make every effort to ensure incorporation of the latest best evidence during implementation of sepsis improvement projects.