Interventions for Improved Time to Antibiotic Administration in Pediatric Patients With Febrile Neutropenia

Abstract

Background: For pediatric patients with suspected neutropenic fever in the emergency department, the gold standard antibiotic administration time is 60 min upon presentation. Unfortunately, this is difficult to achieve given operational delays and the lack of multidisciplinary collaboration. Objective: To implement quality improvement strategies to improve the time to antibiotic administration for pediatric patients with suspected neutropenic fever. Methods: Eligible participants included children with suspected febrile neutropenia. A chart review was conducted to determine if intravenous antibiotics were administered within 60 min from triage. Various process-driven and educational interventions were then implemented. The primary outcome was mean time to antibiotic administration from triage. Results: From January 2023 to September 2023, 72 patients were evaluated for the pre-interventions group. From October 2023 to April 2024, 93 patients were assessed for the post-interventions group. The mean time to antibiotic decreased from 92 to 39 min (95% confidence interval [CI], 31.42 to 64.11; P < .001), and the percentage of patients receiving antibiotics within 60 min increased from 35 to 88% (95% CI 0.57 to 0.72; P < .001). Prior to interventions, the major source of delay was the time between nurse triaging and physician ordering of the antibiotic. After interventions, the mean time from triaging to ordering decreased from 34 to 16 min (95% CI, 4.34-31.88; P = .0103). Conclusion: In pediatric patients with suspected neutropenic fever in the emergency department, a multidisciplinary approach and identification of delays in antibiotic delivery can be instrumental in reducing the time to antibiotics administration.

Keywords: antibiotics; emergency department; febrile neutropenia; multidisciplinary; pediatrics.