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Affecting Length of Stay in Well-appearing Febrile Infants

Madeline Mier1, James W Antoon2,3, Sarah Sefcovic4

  • 1Division of Hospital Medicine, Department of Pediatrics, Johns Hopkins All Children's Hospital, St Petersburg, Fla.

Pediatric Quality & Safety
|February 12, 2021
PubMed

Insights

A smartphone app did not reduce hospital stays for febrile infants. Length of stay for infants with negative sepsis evaluations was the main driver, indicating a need for further research.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Health Services Research

Background:

  • Fever management in infants under two months old presents a long-standing clinical challenge.
  • The REVISE (Reducing Variation in Infant Sepsis Evaluations) study aimed to standardize care for febrile infants.
  • Previous approaches have not consistently reduced length of stay (LOS) for this patient population.

Purpose of the Study:

  • To decrease the length of stay (LOS) for well-appearing febrile infants by 20% over an 8-month intervention period.
  • To evaluate the impact of a decision support smartphone application on LOS for febrile infants.
  • To identify factors contributing to prolonged LOS in febrile infants.

Main Methods:

  • A prospective study involving retrospective chart reviews was conducted.
  • Data were collected during baseline (Sept 2015-Aug 2016), intervention (Dec 2016-Aug 2017), and surveillance (Sept 2017-Dec 2018) periods.
  • A decision support smartphone application was introduced to providers caring for febrile infants aged 7-59 days.

Main Results:

  • A total of 1013 infants were screened; 41 met inclusion criteria.
  • The mean length of stay during the baseline period was 48 hours.
  • The intervention did not significantly alter the mean length of stay from the baseline.

Conclusions:

  • Infants with negative diagnostic evaluations for urinary tract infection, bacteremia, or meningitis were the primary drivers of prolonged LOS.
  • Further research is required to develop strategies that effectively reduce LOS in febrile infants, particularly those with confirmed infections.

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