Sepsis — Huddle to Identify Evidence of Organ Dysfunction — Clinical Pathway: Emergency Department, Inpatient and PICU

Sepsis Clinical Pathway — Emergency Department, Inpatient and PICU

Huddle to Identify Evidence of Organ Dysfunction

Perform bedside huddle including clinical exam vital sign review, and available laboratory data to determine current zone.

Note: Huddles may be initiated by any member of the care team, including bedside RN, regardless of active EHR alert.

Recommended Huddle Participants by Care Area

Care Area ED Inpatient (select units) PICU
Huddle Team Composition
  • Bedside Nurse
  • Attending MD or Fellow MD
  • Bedside Nurse
  • Charge Nurse
  • Provider
  • Bedside Nurse
  • Charge Nurse
  • Critical Care Fellow, APP, or hospitalist physician
Huddle Resources
Patients’ clinical status and zone may change over time, so frequent reassessments are indicated.

Huddle Outcomes Zones Definitions

Green Zone:
Low Suspicion for Sepsis		 Yellow Zone:
Sepsis Watcher		 Red Zone:
Sepsis or Septic Shock
Suspected infection or non-infectious syndrome, no clinical shock or concern for sepsis-associated organ dysfunction Suspected infection, no shock. Evaluation for sepsis-associated organ dysfunction Shock or sepsis-associated organ dysfunction

Suggested Reference Values for Identifying Age-Based Vital Sign Abnormalities

Age Tachycardia
(beats per minute)		 Systolic BP
(mmHg)		 Diastolic BP
(mmHg)		 Tachypnea
(breaths per min)
1 month - 1 year > 180 < 75 < 30 > 65
2 - 5 years > 140 < 74 < 35 > 60
6 - 12 years > 130 < 83 < 45 > 30
13 - 18 years > 120 < 90 < 50 > 30
Vital signs cut offs and integration of heart rate parameters in Sepsis EHR Alerts may vary by patient location. Remember, heart rate may be affected by pain, anxiety, medications, and hydration status.

References

  • Goldstein B. Pediatr Crit Care Med, 2005;6
  • Gebara BM. Values for systolic blood pressure. Pediatr Crit Care Med 2005; 6:500
  • Bonafide CP et al. Development of Heart and Respiratory Rate Percentile Curves for Hospitalized Children. Pediatrics 2013; 131 (4): e150-e1157