Commentary: Using experts by experience to enhance transitional age youth mental health services - a commentary on Adu et al. (2022).

BACKGROUND: In their article, 'System Transformation to Enhance Transitional Age Youth Mental Health - A Scoping Review', Joseph Adu et al. consider how, over the last 15 years, youth mental health and the transitional age from adolescents to young adulthood has received increasing attention, with 1 in 5 living with mental illness reported as being under 25. Their research on the transition to adult mental health services identifies a need for innovative, evidence-based approaches to TAY mental health care, in response to the emerging and persistent challenges experienced globally in this area of practice. In responding to this review, the authors support the findings that when youth actively participate in service design, they experience improvements in their own mental health and are able to contribute to the evolution of evidence-based mental health promotion and care. Examples from personal experience and research reiterate the importance of youth voice through all levels of system design. CONCLUSIONS: The benefits of co-production are evident, both in this review and from personal experience, recognising that mental health issues have a major impact on individuals, families, and communities. The use of this approach in developing and improving youth mental health transition services is beneficial for all involved.

A Quality Improvement Collaborative for Pediatric Sepsis: Lessons Learned.

BACKGROUND: Sepsis is a leading cause of morbidity and mortality in children worldwide. Barriers exist for timely recognition and management in emergency care settings. This 1-year quality improvement collaborative sought to reduce mortality from sepsis. METHODS: Fifteen hospitals participated initially. We included children with a spectrum of illness from sepsis to septic shock. The intervention bundle focused on recognition, escalation of care, and the first hour of resuscitation. We conducted monthly learning sessions and disseminated data reports of site-specific and aggregated metrics to drive rapid cycle improvement. RESULTS: Seven sites contributed enough data to be analyzed. Of the 1,173 pediatric patients in the total cohort, 506 presented with severe sepsis/septic shock. Quarterly data demonstrated a mean improvement in initial clinical assessment from 46% to 60% (P < 0.001) and in adherence to the administration of first fluid bolus within 15 minutes from 38% to 46% (P < 0.015). There was no statistically significant improvement in other process metrics. There was no statistically significant improvement in mortality for the total cohort (sepsis to septic shock) or either of the subgroups in either 3- or 30-day mortality. CONCLUSIONS: A quality improvement collaborative focused on improving timely recognition and management of pediatric sepsis to septic shock led to some process improvements but did not show improvement in mortality. Future national efforts should standardize definitions and processes of care for sepsis to septic shock, including the identification of a "time zero" for measuring the timeliness of treatment.