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Improving Time to Antibiotics for Pediatric Oncology Patients With Suspected Infections: An Emergency

Hiromi Yoshida, Kasey J Leger, Min Xu

    Pediatric Emergency Care
    |January 3, 2018
    PubMed

    Insights

    A quality improvement intervention in a pediatric emergency department significantly reduced time to antibiotics for febrile patients with neutropenia. This enhanced patient care and timely treatment for high-risk children.

    Area of Science:

    • Pediatric Emergency Medicine
    • Quality Improvement Science
    • Hematology/Oncology Patient Care

    Background:

    • Fever and neutropenia in pediatric patients necessitate prompt antibiotic administration.
    • Delays in antibiotic treatment are linked to increased pediatric intensive care unit admissions and mortality.
    • A quality improvement initiative was designed to optimize care for this vulnerable population.

    Purpose of the Study:

    • To evaluate the impact of a rapid absolute neutrophil count (ANC) test on antibiotic administration time.
    • To assess the effectiveness of a standardized prearrival process for febrile hematology/oncology patients.
    • To reduce the time to antibiotics for pediatric oncology patients presenting with fever and neutropenia.

    Main Methods:

    • Implementation of a rapid ANC test reducing lab turnaround time from 60 to 10 minutes.
    • Introduction of a standardized prearrival communication pathway between hematology/oncology and the emergency department.
    • Analysis of time from ED arrival to first antibiotic dose using statistical process control from January 2011 to December 2013.

    Main Results:

    • The rapid ANC test increased the proportion of patients receiving antibiotics within 60 minutes from 47% to 60%.
    • The standardized prearrival process further improved this to 69%.
    • Mean time to antibiotics decreased by 21%, from 83 to 65 minutes.

    Conclusions:

    • A two-phase quality improvement intervention successfully expedited antibiotic administration in pediatric emergency departments.
    • The implemented strategies significantly increased the percentage of patients receiving timely antibiotics.
    • These process improvements offer a model for other pediatric emergency departments to enhance critical care delivery.
    Abstract

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