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Effect of Combined Clinical Practice Guideline and Electronic Order Set Implementation on Febrile Infant Evaluation

Russell J McCulloh, Tessa Commers, David D Williams1

  • 1Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City.

Pediatric Emergency Care
|March 30, 2020
PubMed

Insights

Clinical practice guidelines (CPGs) for febrile infants improved adherence to recommendations. Electronic order sets modestly changed antibiotic use and lumbar puncture rates, showing potential for decision aids.

Area of Science:

  • Pediatrics
  • Infectious Disease Management
  • Clinical Practice Guidelines

Background:

  • Management of febrile infants under 60 days for suspected serious infections lacks standardization.
  • Clinical practice guidelines (CPGs) aim to standardize evidence-based care.
  • An urban children's hospital implemented a CPG for febrile infants in 2011, accompanied by an electronic order set and algorithm.

Purpose of the Study:

  • To evaluate the impact of CPG implementation on electronic order set utilization.
  • To assess changes in clinical practices for managing febrile infants.
  • To determine the association between CPG implementation and clinical outcomes.

Main Methods:

  • Retrospective review of febrile infants aged 60 days and younger from February 2009 to January 2013.
  • Comparison of clinical documentation, order set use, management practices, and outcomes pre- and post-CPG implementation.
  • Analysis included 1037 infants pre-CPG and 930 infants post-CPG.

Main Results:

  • Lumbar puncture rates increased in infants aged 29-60 days (56% to 62%, P=0.02).
  • Overall antibiotic use and duration decreased for infants aged 29-60 days (57% to 51%, P=0.02).
  • Electronic order set use reached 80%; no significant changes in blood/urine cultures, diagnosed infections, readmissions, or length of stay were observed.

Conclusions:

  • The CPG and electronic order set modestly influenced antibiotic use and lumbar puncture rates, aligning with recommendations.
  • Embedded prompts within electronic order sets appear to influence clinician decision-making.
  • Decision aids show promise in enhancing adherence to clinical practice guidelines.
Abstract

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