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Improving Timely Antibiotic Administration for Pediatric Oncology Patients With Neutropenic Fever Seen in the
Emily J Woods1, Laura E Walker2, Heather A Heaton2
1Department of Emergency Medicine, University of Utah, Salt Lake City, UT.
Insights
Improving emergency care for pediatric oncology patients with neutropenic fever, this study enhanced empiric antibiotic administration within 60 minutes. The quality improvement initiative successfully increased adherence from 53% to over 90%.
Area of Science:
- Pediatric Oncology
- Emergency Medicine
- Quality Improvement
Background:
- Neutropenic fever in pediatric oncology patients requires prompt antibiotic treatment.
- Baseline adherence to 60-minute empiric antibiotic administration in the emergency department (ED) was 53% before the initiative.
- Key barriers included lack of staff awareness, incomplete electronic records, practice variation, and laboratory prioritization issues.
Purpose of the Study:
- To improve the timely administration of empiric antibiotics to pediatric oncology patients with neutropenic fever in the ED.
- To achieve at least 80% adherence to administering antibiotics within 60 minutes of arrival.
Main Methods:
- Utilized Lean methodology and root cause analysis to identify delays in antibiotic administration.
- Implemented five Plan-Do-Study-Act (PDSA) cycles focusing on patient identification, streamlined access, practice standardization, antibiotic availability, and education.
- Monitored adherence rates monthly.
Main Results:
- Adherence to timely antibiotic administration increased from 73% in 2015 to 95% by 2018.
- Sustained adherence rates above 90% through 2021.
- Demonstrated significant improvement in a critical care metric for a vulnerable patient population.
Conclusions:
- A structured, multifaceted quality improvement approach effectively enhances patient care outcomes in the ED.
- The implemented strategies successfully improved and sustained the timely administration of empiric antibiotics.
- This methodology can be applied to optimize care for pediatric oncology patients with neutropenic fever.
Objective:
To improve the care for pediatric oncology patients with neutropenic fever who present to the emergency department (ED) by administering appropriate empiric antibiotics within 60 minutes of arrival.
Patients And Methods:
We focused on improving the care for pediatric oncology patients at risk of neutropenia who presented to the ED with concern for fever. Our baseline adherence to the administration of empiric antibiotics within 60 minutes for this population was 53% (76/144) from January 1, 2010, to December 21, 2014. During 2015, we reviewed data monthly, finding 73% adherence. We used the Lean methodology to identify the process waste, completed a value-stream map with input from multidisciplinary stakeholders, and convened a root cause analysis to identify causes for delay. The 4 causes were as follows: (1) lack of staff awareness; (2) missing patient information in electronic medical record; (3) practice variation; and 4) lack of clear prioritization of laboratory draws. We initiated Plan-Do-Study-Act cycles to achieve our goal of 80% of patients receiving appropriate empiric antibiotics within 60 minutes of arrival in the ED.
Results:
Five Plan-Do-Study-Act cycles were completed, focusing on the following: (1) timely identification of patients by utilizing the electronic medical record to initiate a page to the care team; (2) creation of a streamlined intravascular access process; (3) practice standardization; (4) convenient access to appropriate antibiotics; and (5) care team education. Timely antibiotic administration increased from 73%-95% of patients by 2018. More importantly, the adherence was sustained to greater than 90% through 2021.
Conclusion:
A structured and multifaceted approach using quality improvement methodologies can achieve and sustain improved patient care outcomes in the ED.
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