A Quality Initiative to Decrease Time to Antibiotics in Children with Sickle Cell Disease and Fever

Area of Science:

• Pediatric Hematology-Oncology
• Infectious Disease Management
• Healthcare Process Improvement

Background:

• Children with sickle cell disease (SCD) face a heightened risk of sepsis due to functional asplenia.
• Timely antibiotic administration (within 60 minutes of triage) is a critical quality indicator for SCD care in the US.
• Feasibility of achieving timely antibiotics in outpatient hematology-oncology settings for SCD patients remained undocumented.

Purpose of the Study:

• To implement and assess a process improvement initiative aimed at increasing timely antibiotic administration in pediatric SCD patients with fever.
• To achieve a target of at least 90% of children with SCD and fever receiving antibiotics within 60 minutes of triage.

Main Methods:

• Implemented a multi-faceted process improvement initiative in a pediatric hematology-oncology outpatient center.
• Interventions included optimizing general clinic workflows, establishing an intravenous access protocol, enhancing staff communication, and developing an electronic order set.

Main Results:

• Baseline timely antibiotic administration for children with SCD and fever was 10%.
• Following interventions, timely antibiotic administration improved significantly to 77% and was maintained.
• Persistent delays were identified, primarily related to order placement efficiency and challenges with intravenous access.

Conclusions:

• It is feasible to enhance timely antibiotic administration for pediatric patients with SCD and fever in outpatient settings.
• Achieving the national quality indicator of ≥90% timely antibiotics requires sustained focus on expediting order placement and improving intravenous access procedures.