An Initiative to Decrease Time to Antibiotics for Patients With Fever and Neutropenia

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Clinical Process Optimization

Background:

• Fever and neutropenia in pediatric patients presents a critical medical emergency.
• Timely antibiotic administration is crucial for managing neutropenic fever and improving patient outcomes.
• Existing processes may lead to delays in antibiotic delivery in pediatric emergency settings.

Purpose of the Study:

• To significantly decrease the time to antibiotic administration for pediatric patients presenting with fever and neutropenia.
• To enhance the efficiency and safety of care for immunocompromised children in the emergency department.

Main Methods:

• A multidisciplinary team conducted thorough process analysis using interviews and data review.
• Key drivers for delay were identified, and Pareto charts prioritized interventions.
• Rapid Plan-Do-Study-Act cycles were employed for intervention testing and implementation.
• Process control charts monitored progress throughout the study period.

Main Results:

• The average time to antibiotic administration decreased from 116 minutes to 55 minutes.
• Variation in antibiotic administration time was significantly reduced (individual moving range mean decreased from 43 to 18 minutes).
• Implementation of a secure text-based messaging platform, a new antibiotic pathway, and enhanced staff/family education contributed to improvements.

Conclusions:

• Multidisciplinary collaboration and rigorous process analysis can substantially improve efficiency in pediatric emergency care.
• Targeted interventions effectively reduced delays in antibiotic administration for high-risk pediatric patients.
• Optimized care pathways enhance the delivery of critical treatments to vulnerable pediatric populations.