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Area of Science:

  • Pediatric critical care
  • Healthcare process improvement
  • Infectious disease management

Background:

  • Pediatric intestinal failure (IF) patients face high morbidity, particularly sepsis from central line-associated bloodstream infections.
  • Adult sepsis research links time to antibiotic administration (TTA) with mortality.
  • Adapting a successful febrile immunocompromised pediatric oncology protocol for IF patients in the emergency department (ED) was explored.

Purpose of the Study:

  • To adapt and implement a process improvement model for timely antibiotic administration in febrile pediatric intestinal failure (IF) patients.
  • To increase the percentage of IF patients receiving antibiotics within 60 minutes of ED arrival from 46% to a target of 90%.

Main Methods:

  • A multidisciplinary team utilized the Model for Improvement framework.
  • Key drivers included pre- and postarrival processes, staff/family engagement, and a focus on failure analysis.
  • Plan-Do-Study-Act cycles targeted family engagement, prearrival efficiency, and postarrival consistency.

Main Results:

  • Evaluated 276 encounters of febrile IF patients from November 2012 to March 2017.
  • Achieved a sustained reduction in median time from arrival to antibiotic administration (TTA), decreasing from 71 to 45 minutes.
  • Reduced TTA to under 60 minutes for 77% of evaluated febrile IF patients.

Conclusions:

  • Process improvement principles are transferable between high-risk pediatric populations.
  • Adaptations are necessary to account for the unique characteristics of different patient groups.
  • This study demonstrates successful translation of a sepsis management protocol to pediatric IF patients.