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Improving Time to Antibiotic Administration in Open Fractures
Fiona A Fimmel1, Emily M Rheaume2, Kelly S Falcone3
1From the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Implementing a quality improvement program significantly reduced antibiotic administration time for pediatric open long-bone fractures, from 113 to 36 minutes, lowering infection risk. This ensures timely treatment for pediatric trauma patients.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Prevention
- Quality Improvement Science
Background:
- Timely antibiotic administration is crucial for reducing infection risk in pediatric open long-bone fractures.
- National guidelines recommend intravenous antibiotics within 60 minutes of emergency department (ED) presentation.
- The study's trauma center historically failed to meet this 60-minute benchmark.
Purpose of the Study:
- To decrease the mean time for antibiotic administration in pediatric open long-bone fracture patients.
- To improve from a baseline of 113 minutes to 60 minutes or less.
Main Methods:
- A multidisciplinary team utilized serial Plan-Do-Study-Act cycles for process refinement.
- Interventions included stakeholder education, an updated antibiotic order set, and workflow modifications.
- Data analysis employed X-moving range control charts; primary outcome was time to antibiotic administration.
Main Results:
- Antibiotic administration time decreased from a baseline of 113 minutes to 36 minutes postintervention.
- The study included 111 patients, with 60 treated after intervention implementation.
- No negative impact was observed on analgesic administration or fracture reduction times.
Conclusions:
- An iterative, multimodal quality improvement approach effectively reduced antibiotic administration time.
- The intervention enhanced adherence to evidence-based protocols for treating pediatric open long-bone fractures.
- This strategy is vital for optimizing initial management and minimizing complications.
Introduction:
Timely antibiotic treatment for pediatric open long-bone fractures is associated with a reduced risk of infection. National guidelines recommend administering intravenous antibiotics within 60 minutes of presentation to the emergency department (ED). Historically, this study's level 1 pediatric trauma center has not met this benchmark. The objective of this study was to improve antibiotic administration time for pediatric patients with open long-bone fractures from a baseline of 113 to 60 minutes or less.
Methods:
A multidisciplinary team used serial Plan-Do-Study-Act cycles to implement and refine ED processes. Key interventions included targeted education for stakeholders, an updated order set with standardized antibiotic recommendations, modification of the existing orthopedic triage workflow, and quality review of eligible cases with feedback provided to treatment teams. Data were analyzed using X-moving range control charts to identify signals of change. The primary outcome measure was the time to appropriate antibiotic administration after arrival at the ED. Use of the newly introduced order set was tracked as a process measure, and time to analgesic and fracture reduction were balancing measures.
Results:
Data collected from September 2020 to March 2025 included 111 patients, 60 of whom were seen postintervention (starting in April 2023). Time to antibiotic administration improved from 113 to 36 minutes. There was a modest improvement in order set usage. Balancing measure times were not negatively impacted.
Conclusions:
The use of an iterative multimodal quality improvement package reduced the time to antibiotic administration and improved adherence to evidence-based protocols for the initial treatment of pediatric open long-bone fractures.
