Affecting Length of Stay in Well-appearing Febrile Infants

The management of infants under 2 months of age presenting with fever has perplexed pediatricians for decades. The University of Illinois at Chicago was selected as one of the primary sites for the REVISE (Reducing Variation in Infant Sepsis Evaluations) study through the American Academy of Pediatrics. Our primary objective was to decrease the length of stay (LOS) for well-appearing febrile infants by 20% over 8 months from December 2016 to August 2017. METHODS: We introduced the use of a decision support smartphone application to providers caring for febrile infants. Monthly retrospective chart review of patients 7–59 days old with fever seen in the emergency department or the inpatient setting was performed from September 2015 to August 2016 for baseline data, from December 2016 to August 2017 for intervention data, and from September 2017 to December 2018 for surveillance data. RESULTS: A total of 1013 patients of ages 7–59 days seen in the emergency department or inpatient unit between September 2015 to December 2018 were screened for study inclusion. Forty-one febrile, well-appearing infants of ages 7–59 days met inclusion criteria. During the baseline period, there was a mean LOS of 48 hours. Intervention and surveillance data did not change the mean from baseline. CONCLUSIONS: Infants with a negative diagnostic evaluation for urinary tract infection, bacteremia, or meningitis drove our LOS. Further study is needed to affect the LOS in febrile infants with diagnoses of urinary tract infection, bacteremia, or meningitis.