Improving Time to Antibiotic Administration in Open Fractures

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.