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Reducing Time to Antibiotics in Children With Intestinal Failure, Central Venous Line, and Fever

Joel D Hudgins1, Vera Goldberg2, Gillian L Fell2,3

  • 1Division of Emergency Medicine and joel.hudgins@childrens.harvard.edu.

Pediatrics
|October 26, 2017
PubMed

Insights

A quality improvement initiative significantly reduced antibiotic administration time in febrile children with intestinal failure (IF) on parenteral nutrition (PN). This intervention improved emergency department (ED) length of stay but did not impact overall hospital or ICU stays.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Disease Management
  • Healthcare Quality Improvement

Background:

  • Children with intestinal failure (IF) on parenteral nutrition (PN) face a high risk of bacteremia.
  • Delays in antibiotic administration for febrile IF patients on PN are linked to increased morbidity and mortality.

Purpose of the Study:

  • To decrease the mean time to intravenous antibiotic administration in febrile children with IF on PN by 50% to under 60 minutes.
  • To evaluate the impact of a quality improvement (QI) initiative on patient outcomes and care processes.

Main Methods:

  • Implemented a 12-month QI initiative in the emergency department (ED) targeting febrile children with IF on PN.
  • Interventions included enhancing provider knowledge, streamlining order entry, providing feedback, and standardizing triage.
  • Analyzed data using statistical process control and time series analysis.

Main Results:

  • Mean time to antibiotics decreased from 112 to 39 minutes.
  • Emergency department length of stay (LOS) reduced from 286 to 247 minutes.
  • No significant changes observed in hospital LOS, ICU LOS, or hypoglycemia rates.

Conclusions:

  • The QI intervention effectively reduced antibiotic administration time for febrile children with IF on PN.
  • Further research is needed to ascertain the impact on overall LOS and mortality.
Abstract

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