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Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients

Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US...

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Autores principales: Spencer, Sandra, Nypaver, MIchele, Hebert, Katherine, Benner, Christopher, Stanley, Rachel, Cohen, Daniel, Rogers, Alexander, Goldstick, Jason, Mahajan, Prashant
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348586/
https://www.ncbi.nlm.nih.gov/pubmed/28321299
http://dx.doi.org/10.1136/bmjquality.u212406.w4933
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author Spencer, Sandra
Nypaver, MIchele
Hebert, Katherine
Benner, Christopher
Stanley, Rachel
Cohen, Daniel
Rogers, Alexander
Goldstick, Jason
Mahajan, Prashant
author_facet Spencer, Sandra
Nypaver, MIchele
Hebert, Katherine
Benner, Christopher
Stanley, Rachel
Cohen, Daniel
Rogers, Alexander
Goldstick, Jason
Mahajan, Prashant
author_sort Spencer, Sandra
collection PubMed
description Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers. We conducted a post project analysis of prospectively collected observational data from children < 18 years visiting these EDs during independently conducted QI projects. Comparisons were made pre to post intervention periods within each institution. All interventions were derived independently using QI methods by each institution. Successful as well as unsuccessful interventions were described and common interventions adopted by all sites identified. A total of 1032 ED patient visits were identified from the three projects. Improvement in median TTA delivery (min) pre to post intervention(s) was 118.5–57.0 at site 1, 163.0–97.5 at site 2, and 188.0–111.5 at site 3 (p<.001 all sites). The eight common interventions were 1) Triage application of topical anesthetic 2) Rapid room placement & triage 3) Resuscitation room placement of ill appearing children 4) Close proximity to central line equipment 5) Antibiotic administration before laboratory analyses 6) Consensus clinical practice guideline establishment 7) Family pre-ED education for fever and 8) Staff project updates. This core set of eight low cost, high yield QI interventions were developed independently by the three ED's which led to substantial reduction in time to antibiotic delivery in children with cancer presenting with fever. These interventions may inform future QI initiatives in other settings caring for febrile pediatric oncology patients.
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spelling pubmed-53485862017-03-20 Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients Spencer, Sandra Nypaver, MIchele Hebert, Katherine Benner, Christopher Stanley, Rachel Cohen, Daniel Rogers, Alexander Goldstick, Jason Mahajan, Prashant BMJ Qual Improv Rep BMJ Quality Improvement Programme Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery (< 60 minutes) has been shown to reduce mortality. We compared patient outcomes and describe interventions from three separate quality improvement (QI) projects conducted in three United States (US) tertiary care pediatric emergency departments (EDs) with the shared aim to reduce time to antibiotic (TTA) to < 60 minutes in febrile pediatric oncology patients (Temperature > 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers. We conducted a post project analysis of prospectively collected observational data from children < 18 years visiting these EDs during independently conducted QI projects. Comparisons were made pre to post intervention periods within each institution. All interventions were derived independently using QI methods by each institution. Successful as well as unsuccessful interventions were described and common interventions adopted by all sites identified. A total of 1032 ED patient visits were identified from the three projects. Improvement in median TTA delivery (min) pre to post intervention(s) was 118.5–57.0 at site 1, 163.0–97.5 at site 2, and 188.0–111.5 at site 3 (p<.001 all sites). The eight common interventions were 1) Triage application of topical anesthetic 2) Rapid room placement & triage 3) Resuscitation room placement of ill appearing children 4) Close proximity to central line equipment 5) Antibiotic administration before laboratory analyses 6) Consensus clinical practice guideline establishment 7) Family pre-ED education for fever and 8) Staff project updates. This core set of eight low cost, high yield QI interventions were developed independently by the three ED's which led to substantial reduction in time to antibiotic delivery in children with cancer presenting with fever. These interventions may inform future QI initiatives in other settings caring for febrile pediatric oncology patients. British Publishing Group 2017-03-07 /pmc/articles/PMC5348586/ /pubmed/28321299 http://dx.doi.org/10.1136/bmjquality.u212406.w4933 Text en © 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/http://creativecommons.org/licenses/by-nc/2.0/legalcode
spellingShingle BMJ Quality Improvement Programme
Spencer, Sandra
Nypaver, MIchele
Hebert, Katherine
Benner, Christopher
Stanley, Rachel
Cohen, Daniel
Rogers, Alexander
Goldstick, Jason
Mahajan, Prashant
Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title_full Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title_fullStr Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title_full_unstemmed Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title_short Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
title_sort successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients
topic BMJ Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348586/
https://www.ncbi.nlm.nih.gov/pubmed/28321299
http://dx.doi.org/10.1136/bmjquality.u212406.w4933
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