Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Arjun Sarin, MD
Start Date
9-5-2023 11:30 AM
End Date
9-5-2023 1:30 PM
Presentation Type
Abstract
Description
Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.
Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.
Methods/Design: An anonymous pre/post survey was administered to providers at a single community ED with questions on demographics, educational preference, comfort level, and 6 case scenarios. Four of the cases were based on particular age groups in the CPG (age 0-7 days, age 8-21 days, age 22-28 days and age 29-60 days). The additional 2 cases focused on special populations (a premature infant and an ill-appearing infant). Each case contained 5-8 questions including such topics as: initial tests and imaging, additional testing/procedures needed based on initial results, patient disposition and proper antibiotic choice should antibiotics be needed. The results of the pre-education survey guided the educational intervention. Education was via a virtual PowerPoint presentation at a mandatory division meeting and subsequent informative email. An immediate post-education follow-up survey of the same 6 case scenarios, in random order, was given to providers that completed survey one, in addition to questions on comfort level and current guideline use.
Results: 20 providers (74%) completed the initial survey via e-mail, with weekly reminders over a 6-week period; 87.5% were physicians. 16 (85%) completed the post-education survey approximately 6 months after survey one with 12 (75%) completing the educational intervention prior to completing survey two. Education was completed either via attending the division meeting or reviewing the educational email. 13 providers (81%) reported the educational intervention improved their comfort in managing febrile infants. All 3 providers indicating no improvement in comfort did not complete the education provided. Using a Wilcoxon signed rank test on a 5 point Likert Scale (Table 1) we noted an increase in comfort in evaluating febrile infants from 56% to 75% of providers being somewhat/very comfortable when comparing pre/post survey (p = 0.17). Further, preliminary data analysis of pre/post survey using McNemar’s test (Table 2) indicates improvement in post education patient disposition (43.6% to 75%, p =0.06) and antibiotic choice (6% to 56%, p< 0.01).
Conclusions: The majority of community ED providers that attended the education reported an increase in overall comfort in managing this population and indicated they planned to use the AAPinformed CPG in their everyday practice. In addition, when comparing one case pre/post education there was improvement in adherence to guidelines with a statistically significant improvement in antibiotic choice and an increase in the correct patient disposition.
Additional Files
1407_Jess Parker-Abstract.pdf (211 kB)Abstract
Table 1 - PAS Abstract.jpg (21 kB)
Table 2 - PAS Abstract.jpg (35 kB)
Included in
Adult and Continuing Education Commons, Emergency Medicine Commons, Higher Education and Teaching Commons, Pediatrics Commons
Pediatric Educational Outreach to a Community Based Emergency Department: Clinical Management of the Febrile Infant
Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.
Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.
Methods/Design: An anonymous pre/post survey was administered to providers at a single community ED with questions on demographics, educational preference, comfort level, and 6 case scenarios. Four of the cases were based on particular age groups in the CPG (age 0-7 days, age 8-21 days, age 22-28 days and age 29-60 days). The additional 2 cases focused on special populations (a premature infant and an ill-appearing infant). Each case contained 5-8 questions including such topics as: initial tests and imaging, additional testing/procedures needed based on initial results, patient disposition and proper antibiotic choice should antibiotics be needed. The results of the pre-education survey guided the educational intervention. Education was via a virtual PowerPoint presentation at a mandatory division meeting and subsequent informative email. An immediate post-education follow-up survey of the same 6 case scenarios, in random order, was given to providers that completed survey one, in addition to questions on comfort level and current guideline use.
Results: 20 providers (74%) completed the initial survey via e-mail, with weekly reminders over a 6-week period; 87.5% were physicians. 16 (85%) completed the post-education survey approximately 6 months after survey one with 12 (75%) completing the educational intervention prior to completing survey two. Education was completed either via attending the division meeting or reviewing the educational email. 13 providers (81%) reported the educational intervention improved their comfort in managing febrile infants. All 3 providers indicating no improvement in comfort did not complete the education provided. Using a Wilcoxon signed rank test on a 5 point Likert Scale (Table 1) we noted an increase in comfort in evaluating febrile infants from 56% to 75% of providers being somewhat/very comfortable when comparing pre/post survey (p = 0.17). Further, preliminary data analysis of pre/post survey using McNemar’s test (Table 2) indicates improvement in post education patient disposition (43.6% to 75%, p =0.06) and antibiotic choice (6% to 56%, p< 0.01).
Conclusions: The majority of community ED providers that attended the education reported an increase in overall comfort in managing this population and indicated they planned to use the AAPinformed CPG in their everyday practice. In addition, when comparing one case pre/post education there was improvement in adherence to guidelines with a statistically significant improvement in antibiotic choice and an increase in the correct patient disposition.
