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Clinical Pathway Effectiveness: Febrile Young Infant Clinical Pathway in a Pediatric Emergency Department
Ashlee Lynn Murray1, Elizabeth Alpern, Jane Lavelle
1From the *The Children's Hospital of Philadelphia, Philadelphia, PA; and †Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
A standardized clinical pathway in the emergency department (ED) significantly improved the timeliness of care for febrile young infants. This pathway led to faster work-ups and earlier antibiotic administration, enhancing patient outcomes.
Area of Science:
- Pediatrics
- Emergency Medicine
- Clinical Pathway Implementation
Background:
- Febrile illnesses in young infants present diagnostic and management challenges in emergency departments (EDs).
- Delays or ineffective care for febrile infants can increase morbidity and mortality.
- Standardized clinical pathways are proposed to optimize care delivery.
Purpose of the Study:
- To evaluate the impact of a clinical pathway for febrile young infants in a children's hospital ED.
- To assess improvements in the timeliness and consistency of care.
- To analyze the effect on diagnostic work-up and therapeutic interventions.
Main Methods:
- A retrospective observational study design comparing before-and-after pathway implementation.
- Inclusion criteria: infants ≤56 days old with rectal temperature ≥38.0°C.
- Exclusion criteria: transfer patients or those developing fever post-presentation.
Main Results:
- Pathway implementation reduced time to urine collection by 23 minutes and to first antibiotic by 36 minutes.
- Increased proportion of infants receiving age-appropriate antibiotics (OR 7.2) and acyclovir (OR 8.8).
- Demonstrated significant improvements in adherence to guideline-specific treatments.
Conclusions:
- An ED-based clinical pathway for febrile young infants enhances care efficiency.
- The pathway expedites diagnostic work-up (urine collection) and therapeutic interventions (antibiotics).
- Implementation led to decreased variability and improved consistency in patient management.
Objective:
Young infants are often treated in emergency departments (EDs) for febrile illnesses. Any delay in care or ineffective management could lead to increased patient morbidity and mortality. A standardized ED clinical pathway may improve care for these patients. The objective of this study is to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care.
Methods:
This study used a before-and-after retrospective observational study design comparing 2 separate periods: prepathway from September 2007 through August 2008 and postpathway from September 2009 through August 2010. Subjects were infants aged 56 days or younger presenting with a rectal temperature of 38.0°C or higher. Patients were excluded if they were transferred from another hospital or if they developed a fever after initial presentation.
Results:
Five hundred twenty infants were enrolled. The mean time to urine collection and time to the first antibiotic administration were reduced after pathway implementation (23-minute reduction to urine collection vs 36-minute reduction to the first antibiotic administration). There was improvement in the proportion of infants who received the pathway-specific antibiotics based on age (odds ratio, 7.2; 95% confidence interval, 4.4, 11.9) and the proportion of infants who were administered acyclovir based on pathway guidelines (odds ratio, 8.8; 95% confidence interval, 2.9-30.0).
Conclusions:
An ED-based febrile young infant clinical pathway improved the timeliness of initiation of work-up as measured by urine collection and of therapy by an earlier administration of the first antibiotic, as well as decreased variability of care.
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