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Initiative reduced time to antibiotic administration in ED
Study findings in Pediatrics showed a multidisciplinary ED initiative significantly improved time to antibiotic administration among children with central lines who presented with fever.
“We designed an ED initiative to address our key care delivery problem (ie, delayed antibiotic administration) … regardless of underlying condition,” study researcher Meghan Jobson, PhD, of the University of North Carolina, and colleagues wrote. “The primary aim of the initiative was to achieve 90% of patients receiving antibiotics within 60 minutes of ED arrival; our secondary goal was to reduce mean [time to antibiotic administration] to less than 60 minutes and narrow the variation.”
Meghan Jobson
Researchers conducted the initiative at a large suburban academic medical center in Durham, N.C., in three phases. In phase 1, researchers defined the problem, discussed baseline results and initiative endpoints with ED staff, eliminated the step of contacting the patient’s subspecialist before treatment and implemented initiative solutions. Phase 2 restructured patient identification and acuity assignment processes. In phase 3, lessons learned and data from phases 1 and 2 were used to redesign a standard patient identification and management process. Outcomes were assessed 8 months later.
“The primary strategies used in the present initiative focused on staff engagement and learning from collected and analyzed data,” the researchers wrote. “Effective communication, awareness of staff performance (by using data collection, analysis and result reporting in real-time), and timely individual feedback provided the framework to deploy these strategies.”
During the study period, 479 children with central lines presented to the ED with fever. The percentage of patients receiving antibiotics within 60 minutes of arrival to the ED increased from 63% to 99% by 8 months after initiative implementation.
Time to antibiotic administration decreased from a monthly mean of 65 minutes to 30 minutes and “reliably” was less than 1 hour by phase 3. This outcome was sustained for 24 months after initiative goals were met in June 2011, according to researchers.
Baseline data from 2010 indicated black patients had longer delays to antibiotic administration compared with patients of other races (95 minutes vs. 61 minutes; P<.05). Implementation of the initiative improved this gap, however, and time to antibiotic administration was similar between all racial groups in phase 3.
“The present initiative achieved and consistently sustained a goal of rapidly delivering antibiotics to febrile pediatric patients with central lines,” Jobson and colleagues wrote. “We attribute much of the success of our efforts to both the involvement of an effective staff caregiver champion who encouraged a culture shift from complacent routine to active engagement and a deliberate plan to seek feedback from the front line to improve the process.”
Disclosure: The researchers report no relevant financial disclosures.
