Effect of Combined Clinical Practice Guideline and Electronic Order Set Implementation on Febrile Infant Evaluation and Management.
Document Type
Article
Publication Date
1-1-2021
Identifier
DOI: 10.1097/PEC.0000000000002012
Abstract
OBJECTIVE: Management of febrile infants 60 days and younger for suspected serious infection varies widely. Clinical practice guidelines (CPGs) are intended to improve clinician adherence to evidence-based practices. In 2011, a CPG for managing febrile infants was implemented in an urban children's hospital with simultaneous release of an electronic order set and algorithm to guide clinician decisions for managing infants for suspected serious bacterial infection. The objective of the present study was to determine the association of CPG implementation with order set use, clinical practices, and clinical outcomes.
METHODS: Records of febrile infants 60 days and younger from February 1, 2009, to January 31, 2013, were retrospectively reviewed. Clinical documentation, order set use, clinical management practices, and outcomes were compared pre-CPG and post-CPG release.
RESULTS: In total, 1037 infants pre-CPG and 930 infants post-CPG implementation were identified. After CPG release, more infants 29 to 60 days old underwent lumbar puncture (56% vs 62%, P = 0.02). Overall antibiotic use and duration of antibiotic use decreased for infants 29 to 60 days (57% vs 51%, P = 0.02). Blood culture and urine culture obtainment remained unchanged for older infants. Diagnosed infections, hospital readmissions, and length of stay were unchanged. Electronic order sets were used in 80% of patient encounters.
CONCLUSIONS: Antibiotic use and lumbar puncture performance modestly changed in accordance with CPG recommendations provided in the electronic order set and algorithm, suggesting that the presence of embedded prompts may affect clinician decision-making. Our results highlight the potential usefulness of these decision aids to improve adherence to CPG recommendations.
Journal Title
Pediatric emergency care
Volume
37
Issue
1
First Page
25
Last Page
31
MeSH Keywords
Algorithms; Bacterial Infections; Clinical Decision-Making; Fever; Guideline Adherence; Humans; Infant; Infant, Newborn; Medical Order Entry Systems; Patient Readmission; Practice Guidelines as Topic; Retrospective Studies
Keywords
Algorithms; Bacterial Infections; Clinical Decision-Making; Fever; Guideline Adherence; Humans; Infant; Infant, Newborn; Medical Order Entry Systems; Patient Readmission; Practice Guidelines as Topic; Retrospective Studies
Recommended Citation
McCulloh RJ, Commers T, Williams DD, Michael J, Mann K, Newland JG. Effect of Combined Clinical Practice Guideline and Electronic Order Set Implementation on Febrile Infant Evaluation and Management. Pediatr Emerg Care. 2021;37(1):e25-e31. doi:10.1097/PEC.0000000000002012
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