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Background: Hematology/oncology (H/O) patients have been screened for sepsis since 2013 at a pediatric hospital. Using sepsis screening (Ss) tool, results, and addition of organ dysfunction screening (ODs), decision tree (DT) was designed (Fig. 1) for nurses to identify sepsis and intervene. Objectives: Positive Ss require multiple assessments by nurses and H/O physicians creating sepsis alert fatigue. By implementing DT, calls to H/O physicians for sepsis alerts could be reduced 24% without increasing misses of patients with sepsis. Methods: Patients with Ss < 4 considered negative; Ss > 4 positive. ODs < 2 considered negative, = 2 at risk, > 2 positive for sepsis. In 2016, Ss were performed on H/O patients upon admission, status change, or nurse concern. May 2017, DT was implemented on H/O. From 5/5/17 to 8/30/17 Ss and ODs were conducted every 12 hours or with status change (Fig. 2). Results: Design period: 1,457 Ss (n = 1,393); 200 Ss positive (n = 180); 8 Ss, ODs < 2 (n = 44); 152 Ss, ODs = 2 (n = 139); and 0 Ss, ODs > 2. Implementation period: 6,502 Ss (n = 512); 1,647 Ss positive (n = 292); 293 Ss, ODs < 2 (n = 72); 1,351 Ss, ODs = 2 (n = 265); and 30 Ss, ODs > 2 (n = 14). See Figure 3 for pediatric intensive care unit (PICU) transfers during design/implementation periods. Conclusions/Implications: During implementation, calls were reduced to H/O physicians by 17.5% (ODs < 2). Most patients were ODs = 2. Recommendations included calling physician only if nurse was concerned of patient’s status with OD = 2. DT with addition of ODs has increased awareness of sepsis and communication between transferring providers. We have not found an increase in sepsis misses requiring transfer to PICU.

Decision Tree Model for Hematology/Oncology Patients with Severe and Nonsevere Sepsis