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CHAPEL HILL, NC – Pediatric patients who have central lines and present to the ED with fever require rapid antibiotic administration, but that doesn’t always happen as quickly as it should.
To remedy that, University of North Carolina, Chapel Hill, researchers conducted an ED improvement initiative with the goal of delivering antibiotics to 90% of those patients within an hour while also minimizing process variation.
According to a report published online recently by the journal Pediatrics, the initiative more than met the goal, sustaining that timetable for at least 24 months. In addition, it eliminated race-based discrepancies in care.
In the academic ED, a multidisciplinary team was assembled, identified contributing factors to the care delivery problem were identified, and key drivers and intervention steps were determined. When the changes were implemented, the researchers used strategies to engage ED staff and promote sustainability.
Outcomes, analyzed by using a time series design with baseline data and continuous postintervention monitoring, included percentage of patients receiving antibiotics within 60 minutes, time to antibiotic administration, and accuracy for triage acuity and chief complaint.
The intervention began after an 8-month baseline period where 63% of patients received antibiotics within 60 minutes of arrival with a mean time to antibiotics of 65 minutes. After multiple Plan-Do-Study-Act (PDSA) cycles were used to improve patient identification and initial management processes, the percentage of patients receiving antibiotics within 60 minutes of arrival was increased to 99% (297 of 301). Mean time to antibiotic administration, meanwhile decreased to 30 minutes.
After two years, the ED still met the goals.
Interestingly, the intervention did more than originally planned. After subanalysis identified a racial discrepancy, with African-American patients experiencing significantly longer delays of an average of 95 minutes compared to patients of other races who received antibiotics within 61 minutes, the initiative eliminated that discrepancy also.