The average time it takes to deliver antibiotics to febrile children with a central line can be improved with an appropriately planned hospital intervention, a recent study found.
The University of North Carolina Hospitals, Chapel Hill, emergency department, which cares for approximately 14,000 patients under 19 years each year, set out to identify barriers to timely administration of antibiotics to pediatric patients with a central line who presented with fever. An 8-month baseline analysis showed only 63% of patients received antibiotics within 60 minutes, and the average time to receive antibiotics was 65 minutes.
The hospital formed an improvement team that included nursing staff, attending physicians, and volunteer research assistants to improve timing of antibiotic delivery to these patients. Their goals included delivering antibiotics within 60 minutes to 90% of patients, reducing the average delivery time to less than 60 minutes and reducing variation of times among different demographic groups. From January 2010, when the baseline analysis began, through June 2013, the team tracked 479 patient encounters.
“Key areas for improvement included patient identification at triage, appropriate level of triage assigned, antibiotic availability, and a standard management process,” reported Meghan Jobson, Ph.D., and her associates at the University of North Carolina, Chapel Hill, reported online Dec. 8 (Pediatrics 2014 [doi: 10.1542/peds.2014-1192]). The three-phase initiative involved communicating the baseline analysis and goals to the staff, removing the step of contacting patients’ subspecialists before treatment, addressing patient identification and triage issues, and continually refining procedures with ongoing staff coaching.
Eight months after the initiative began, 99% of patients received antibiotics within 60 minutes and average time to delivery dropped to 30 minutes. Since meeting that goal, the hospital has maintained antibiotic delivery within 60 minutes for more than 90% of patients for 24 subsequent months. Further, the significantly longer delays in antibiotic delivery to black patients that had shown up in the baseline analysis no longer existed once the initiative had been fully implemented.
The study did not receive external funding, and the authors reported no disclosures.