A Prospective Cohort Quality Improvement Study to Reduce the Time to Antibiotics for New Fever in Neutropenic Pediatric Oncology Inpatients

BackgroundFever and neutropenia (F&N) is a pediatric oncology emergency due to the risk of disseminated infection. Quality improvement (QI) efforts to improve time to antibiotics for F&N in the emergency department have been documented, but the issue has not been studied in the established inpatient setting. ProcedureWe undertook a prospective cohort QI study to decrease time to antibiotics for neutropenic pediatric oncology inpatients with new fever to <60min. Our key intervention was discussion of a plan in case of new fever, including antibiotic(s) to be started, for each patient on rounds. Timing for each step in the process, from fever identification to antibiotic administration, was measured through the electronic medical record for each fever event. ResultsThe median time to antibiotics during the 3-three month intervention study period was 76.0min, although the distribution was skewed due to several long outliers (mean 142.5, interquartile range 51-206, range 47-593min). Time to antibiotics was significantly shorter when a fever contingency plan was documented in the most recent note than not (mean 102 vs. 254min, P=0.039). Over the total 2.75year data-collection period, the quarterly percentage of patients receiving antibiotics within 60min has improved from 35 to 65, whereas quarterly mean time to antibiotics has improved from 99 to 50min. ConclusionsDaily discussion of a fever contingency plan appears effective in decreasing the time to antibiotics for neutropenic pediatric oncology inpatients with new fever, likely by circumventing the need for multi-level discussion of the antibiotic plan when fever is identified. Pediatr Blood Cancer 2015; 9999:XX-XX (c) 2015 Wiley Periodicals, Inc.