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  • Quality Improvement Article
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Implementation of the sepsis risk score for chorioamnionitis-exposed newborns

Journal of Perinatology volume 38, pages 1581–1587 (2018)Cite this article

Subjects

Abstract

Background:

To prevent early onset sepsis (EOS), ~10% of neonates receive antibiotics based on CDC recommendations regarding chorioamnionitis exposure. A sepsis risk score (SRS) predicts EOS and spares unnecessary evaluation and treatment.

Local problem:

Chorioamnionitis-exposed neonates utilize significant resources.

Methods:

An SRS algorithm was implemented to decrease resource utilization in chorioamnionitis-exposed neonates ≥35 weeks’. Outcome measures included antibiotic exposure, time in NICU, laboratory evaluations, and length of stay (LOS). Balancing measures were missed cases of EOS and readmissions. Data were assessed using run charts.

Interventions:

Plan-Do-Study-Act cycles were utilized to process map, implement and reinforce the algorithm.

Results:

A number of 356 patients met inclusion criteria. After algorithm implementation, antibiotic exposure reduced from 95 to 9%, laboratory evaluation from 96 to 22%, NICU observation from 73 to 10%. LOS remained unchanged. No missed cases of EOS, nor sepsis readmissions.

Conclusions:

Algorithm implementation decreased antibiotic and resource utilization without missing cases of EOS.

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Acknowledgements

The authors thank the care providers in Labor & Delivery, MBU and NICU at OHSU. We thank Jose Rodriguez for data collection. The generous support from the Friends of Doernbecher cannot be understated. We also thank the neonates and families for giving us the opportunity to be involved in their care.

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Authors and Affiliations

  1. Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA

    Ladawna L Gievers, Carrie A Phillipi, Dmitry Dukhovny & Sheevaun Khaki

  2. School of Medicine, University of Arizona, Tucson, AZ, USA

    Jennifer Sedler

  3. Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, OR, USA

    Jonah Geddes & Peter Graven

  4. School of Public Health, Oregon Health and Science University, Portland, OR, USA

    Benjamin Chan

Authors
  1. Ladawna L Gievers
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  2. Jennifer Sedler
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  3. Carrie A Phillipi
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  4. Dmitry Dukhovny
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  5. Jonah Geddes
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  6. Peter Graven
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  7. Benjamin Chan
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  8. Sheevaun Khaki
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Corresponding author

Correspondence to Ladawna L Gievers.

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Conflict of interest

Dr. Dukhovny is on faculty and a consultant for Vermont Oxford Network. All phases of this study were supported by the Friends of Doernbecher Foundation

Ethical considerations

The study was approved by the OHSU institutional review board.

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Gievers, L.L., Sedler, J., Phillipi, C.A. et al. Implementation of the sepsis risk score for chorioamnionitis-exposed newborns. J Perinatol 38, 1581–1587 (2018). https://doi.org/10.1038/s41372-018-0207-7

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  • DOI: https://doi.org/10.1038/s41372-018-0207-7

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