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Effects of a pediatric emergency department febrile infant protocol on time to antibiotic therapy

G Q Sharieff1, C Hoecker, P D Silva

  • 1Department of Pediatric Emergency Medicine, Children's Hospital and Health Center/University of California, San Diego, California, USA

The Journal of Emergency Medicine
|June 12, 2001
PubMed

Insights

A new Emergency Department (ED) protocol significantly reduced the time to administer antibiotics for febrile infants under 3 months old. This quality improvement initiative improved patient care by shortening the median antibiotic administration time by 25%.

Area of Science:

  • Pediatrics
  • Emergency Medicine
  • Quality Improvement

Background:

  • Febrile infants less than 3 months old require prompt evaluation and treatment.
  • Timely antibiotic administration is crucial for managing potential serious infections in this population.

Purpose of the Study:

  • To evaluate the impact of an Emergency Department (ED) protocol on reducing the time to antibiotic administration for febrile infants (<3 months old).
  • To assess the effectiveness of a quality improvement initiative in streamlining care for febrile infants.

Main Methods:

  • A before-and-after study design was employed in an urban pediatric ED.
  • Data were collected on infants <3 months with rectal temperature ≥38.0°C undergoing a full septic work-up.
  • The "Septic Infant Work-up Sheet" and Febrile Infant Protocol interventions were implemented.
  • Kaplan-Meier survival estimates and log-rank tests were used for data analysis.

Main Results:

  • The median time to antibiotic administration decreased from 142 minutes before the protocol to 105 minutes after.
  • This represents a statistically significant 25% reduction in the time from presentation to antibiotic administration.
  • Patient demographics and illness severity remained similar, indicating the protocol change was the primary driver of the time reduction.

Conclusions:

  • A guideline-based ED Febrile Infant Protocol effectively changed clinical practice.
  • The implemented protocol significantly improved the timeliness of antibiotic administration in febrile infants.
  • Quality improvement initiatives can successfully optimize ED care pathways for vulnerable pediatric populations.

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