Improving Antibiotic Administration Time in At-Risk Pediatric Populations: A Quality Improvement Project

Bacterial sepsis is a life-threatening concern for pediatric patients with a history of sickle cell disease, oncological disease, and/or neutropenia who present with fever. Prompt antibiotic administration is critical. However, studies show that many hospitals fail to meet the 60-minute benchmark for high-risk patients, despite its known benefits.

This quality improvement initiative aimed to ensure that at least 80% of the target population received antibiotics within 60 minutes of emergency department registration. The Plan-Do-Study-Act model was used, and data were collected through electronic medical record audits, measuring time to antibiotics from registration to administration. SPSS 27 and a 2-proportion z-test analyzed time to antibiotics improvement.

Pre- (n = 137) and postintervention groups (n = 638) were demographically similar. The mean age was 6.5 years before and 7.4 years after intervention, with a balanced sex distribution. Most patients were Black or African American, with clinical presentations including hematology with fever (9.6%), oncology with fever (40.4%), or sickle cell disease with fever (50%). Significant improvement was noted in the proportion of targeted patients receiving antibiotics in <60 minutes between January 2022 and May 2024. The time to antibiotics within goal of patients with oncology improved from 45.2% to 90%, patients with hematology from 42.9% to 81.6%, and patients with sickle cell disease from 44% to 85.1%. Overall time to antibiotics improved from 44.4% to 86.7%.

The initiative significantly improved timely antibiotic administration. By 2024, 95% of patients received antibiotics within 60 minutes. Enhanced nursing autonomy and team-based strategies were key drivers of success, promoting safer care and sustained quality improvement.