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. 2016 Nov;32(11):739-745.
doi: 10.1097/PEC.0000000000000362.

Protocol for Reducing Time to Antibiotics in Pediatric Patients Presenting to an Emergency Department With Fever and Neutropenia: Efficacy and Barriers

Clay Cohen  1 , Amber King, Chee Paul Lin, Gregory K Friedman, Kathy Monroe, Matthew Kutny
Affiliations

Protocol for Reducing Time to Antibiotics in Pediatric Patients Presenting to an Emergency Department With Fever and Neutropenia: Efficacy and Barriers

Clay Cohen et al. Pediatr Emerg Care. 2016 Nov.

Abstract

Objectives: Patients with febrile neutropenia are at high risk of morbidity and mortality from infectious causes. Decreasing time to antibiotic (TTA) administration is associated with improved patient outcomes. We sought to reduce TTA for children presenting to the emergency department with fever and neutropenia.

Methods: In a prospective cohort study with historical comparison, TTA administration was evaluated in patients with neutropenia presenting to the Children's of Alabama Emergency Department. A protocol was established to reduce delays in antibiotic administration and increase the percentage of patients who receive treatment within 60 minutes of presentation. One hundred pre-protocol patient visits between August 2010 and December 2011 were evaluated and 153 post-protocol visits were evaluated between August 2012 and September 2013. We reviewed individual cases to determine barriers to rapid antibiotic administration.

Results: Antibiotics were administered in 96.9 ± 57.8 minutes in the pre-protocol patient group, and only 35% of patients received antibiotics within 60 minutes of presentation and 70% received antibiotics within 120 minutes. After implementation of the protocol, TTA for neutropenic patients was decreased to 64.3 ± 28.4 minutes (P < 0.0001) with 51.4% receiving antibiotics within 60 minutes and 93.2% within 120 minutes.

Conclusions: Implementing a standard approach to patients at risk for neutropenia decreased TTA. There are numerous challenges in providing timely antibiotics to children with febrile neutropenia. Identified delays included venous access (time to effect of topical anesthetics, and difficulty obtaining access), physicians waiting on laboratory results, and antibiotic availability.

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Figures

Figure 1
Figure 1
Protocol for febrile patients at risk for neutropenia presenting to the emergency department
Figure 2
Figure 2
Mean time to antibiotic administration was significantly decreased following implementation of a standardized care protocol in the emergency department.
Figure 3
Figure 3
Percentage of patients receiving antibiotics within 60 and 120 minutes improved following implementation of standardized care protocol.
Figure 4
Figure 4
Time to antibiotics (TTA) by quarter following implementation of protocol. Mean TTA decreased significantly from quarter 1 to 4 (a), and percentage of cases with TTA less than 60 and 120 minutes increased significantly from quarter 1 to 4 (b).
Figure 4
Figure 4
Time to antibiotics (TTA) by quarter following implementation of protocol. Mean TTA decreased significantly from quarter 1 to 4 (a), and percentage of cases with TTA less than 60 and 120 minutes increased significantly from quarter 1 to 4 (b).
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References

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