Improving Guideline-Concordant Care for Febrile Infants Through a Quality Improvement Initiative

Area of Science:

• Pediatrics
• Quality Improvement Science
• Clinical Practice Guidelines

Background:

• The American Academy of Pediatrics (AAP) released a Clinical Practice Guideline (CPG) in August 2021 for managing well-appearing febrile infants aged 8 to 60 days.
• Adherence to CPGs is crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To evaluate the impact of a quality improvement (QI) collaborative on adherence to specific AAP CPG recommendations.
• To assess the effectiveness of a multifaceted intervention bundle in improving care for febrile infants.

Main Methods:

• A QI collaborative was implemented across 103 hospitals in the US and Canada.
• A multifaceted intervention bundle targeted 4 primary and 4 secondary measures, with 5 balancing measures tracked.
• Statistical process control (SPC) was used for data analysis from November 2020 to October 2022.

Main Results:

• The QI collaborative demonstrated improvements in adherence to primary and secondary measures.
• Highest adherence was observed for not obtaining cerebrospinal fluid (92.4%) and not administering antibiotics (90.0%) in qualifying infants.
• Significant improvements were noted in parent engagement for discharge (16.0%) and oral antibiotic use for positive urinalysis (20.4%).

Conclusions:

• A QI collaborative, utilizing a multifaceted intervention, successfully improved adherence to key AAP CPG recommendations for febrile infants.
• The intervention demonstrated positive impacts on specific care pathways without negatively affecting critical safety outcomes.