Pediatric Patients Who Receive Antibiotics for Fever and Neutropenia in Less Than 60 min Have Decreased Intensive Care Needs

BackgroundAntibiotic delivery to patients with fever and neutropenia (F&N) in <60min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N. ProcedureWe used Lean-Methodology and a Plan-Do-Study-Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub-process times, and clinical outcomes. ResultsOur QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60min nearly 100% of the time. All TTA sub-process times also improved. Moreover, achieving TTA <60min significantly reduced the need for ICU consultation or admission (P=0.003) in this population. ConclusionHere we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N. Pediatr Blood Cancer 2015;62:807-815. (c) 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.