A Quality Improvement Initiative to Decrease Time to Antibiotics for Children with Intestinal Failure, Fever, and a Central Line
| Autor: | Jean Simpkins, Yue Zhang, Adam G. Mezoff, Ethan A. Mezoff, Janis Chiarenzelli, Mary Dewald, Conrad R. Cole, Selena Hariharan, Christopher E. Dandoy, Kim Klotz, Misty Troutt |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Central line Quality management Time to antibiotic business.industry medicine.drug_class Population Antibiotics Building and Construction Emergency department medicine.disease Sepsis 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Intestinal failure Emergency medicine medicine 030212 general & internal medicine business education |
| Zdroj: | Pediatric qualitysafety. 3(4) |
| ISSN: | 2472-0054 |
| Popis: | Introduction Pediatric intestinal failure (IF) patients experience significant morbidity, including sepsis related to central line-associated bloodstream infections. Adult studies of sepsis demonstrate an association between time to antibiotic administration (TTA) and mortality. To overcome challenges in treating pediatric IF patients in an emergency department (ED), we appropriated an existing, reliable system for febrile immunocompromised oncology/bone marrow transplant children. We describe the translation of this process to febrile IF patients in the ED and steps toward sustained improvement. Methods We formed a multidisciplinary team and used the Model for Improvement to define aims and identify key drivers. The goal was to use an existing improvement process to increase the percentage of patients with IF who receive antibiotics within 60 minutes of arrival to the ED from 46% to 90%. Key drivers included pre- and postarrival processes, staff and family engagement, and a preoccupation with failure. We performed Plan-Do-Study-Act cycles targeting family engagement, prearrival efficiency, and postarrival consistency. Results Two hundred seventy-six encounters involving febrile IF patients between November 2012 and March 2017 were evaluated. There was a sustained reduction in the median time from arrival to antibiotic administration (71-45 minutes). We decreased TTA to less than 60 minutes for 77% of febrile IF patients. Conclusions The basic tenets of process improvement for 1 high-risk population can be translated to another high-risk population but must be adjusted for variability in characteristics. |
| Databáze: | OpenAIRE |
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