Presenter Status
Resident/Psychology Intern
Abstract Type
QI
Primary Mentor
Leslie Hueschen
Start Date
16-5-2025 11:30 AM
End Date
16-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Oncology patients are at a high risk for sepsis, due to chemotherapy-induced immunosuppression and neutropenia as well as presence of a central venous catheter. Due to the high risk of sepsis, these patients require antibiotics within 60 minutes of Emergency Department (ED) arrival. During our baseline period, Sept 2022-May 2023, we only achieved this 38% of the time at Children’s Mercy ED.
Aim: By April 30th, 2024, we will increase the percentage of ED febrile oncology patients receiving antibiotics < 60 min of arrival from 36.6% to 80%, stratifying by race and ethnicity, to monitor for inequities.
Methods: Our outcome measures were the percentage of ED febrile oncology patients with antibiotics given < 60 min of arrival and the median time to antibiotic administration. Our process measures were the percentage of standard order-set usage and percentage of patients with critical information notes. Our balance measure was time from arrival to ED triage. We created a process map and fishbone diagram and identified several delays in antibiotics administration. We performed interventions with Plan-Do-Study-Act methodology. First, we implemented standing nursing orders to decrease the time spent waiting for a provider to order antibiotics (June 2024). Next, the outpatient oncology providers created a Critical Information Note, which directed prompt antibiotic administration prior to labs or consultation (August 2024). To engage physicians, we made this a Maintenance of Certification (MOC) project, with monthly review of run charts (Oct 2024). Next, we prioritized timely access of the patients’ central line, with a nursing script to communicate with families the importance of accessing their child’s central line as soon as possible (Oct 2024). We created a Central Line Note, identifying the type of central line and needle size required to access the line (March 2024).
Results: With the implementation of these interventions, antibiotic administration < 60 min of ED arrival in febrile oncology patients increased from 36.6% to 54%, and median time to antibiotics decreased from 71.5 minutes to 55 minutes (Figure 1, 2). Decrease in inequities were noted most significantly in the Hispanic population (101 min to 77 min; 35% improvement compared to 17%). Total order set usage (0 to 83%) and critical information note placement increased (from 0 to 78%) without a shift in our balance measure.
Conclusion: Although we did not achieve our goal, we improved the variability and percentage of febrile oncology patients receiving antibiotics < 60 min and saw decreases in inequities. The most impactful intervention was having nurses order antibiotics, since they have first contact with patients, and sustainability was achieved by providing MOC physician credit with monthly data review.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Quality Improvement Commons
Decreasing time to antibiotics in febrile oncology patients with central line in the pediatric emergency department; A Quality Improvement initiative
Background: Oncology patients are at a high risk for sepsis, due to chemotherapy-induced immunosuppression and neutropenia as well as presence of a central venous catheter. Due to the high risk of sepsis, these patients require antibiotics within 60 minutes of Emergency Department (ED) arrival. During our baseline period, Sept 2022-May 2023, we only achieved this 38% of the time at Children’s Mercy ED.
Aim: By April 30th, 2024, we will increase the percentage of ED febrile oncology patients receiving antibiotics < 60 min of arrival from 36.6% to 80%, stratifying by race and ethnicity, to monitor for inequities.
Methods: Our outcome measures were the percentage of ED febrile oncology patients with antibiotics given < 60 min of arrival and the median time to antibiotic administration. Our process measures were the percentage of standard order-set usage and percentage of patients with critical information notes. Our balance measure was time from arrival to ED triage. We created a process map and fishbone diagram and identified several delays in antibiotics administration. We performed interventions with Plan-Do-Study-Act methodology. First, we implemented standing nursing orders to decrease the time spent waiting for a provider to order antibiotics (June 2024). Next, the outpatient oncology providers created a Critical Information Note, which directed prompt antibiotic administration prior to labs or consultation (August 2024). To engage physicians, we made this a Maintenance of Certification (MOC) project, with monthly review of run charts (Oct 2024). Next, we prioritized timely access of the patients’ central line, with a nursing script to communicate with families the importance of accessing their child’s central line as soon as possible (Oct 2024). We created a Central Line Note, identifying the type of central line and needle size required to access the line (March 2024).
Results: With the implementation of these interventions, antibiotic administration < 60 min of ED arrival in febrile oncology patients increased from 36.6% to 54%, and median time to antibiotics decreased from 71.5 minutes to 55 minutes (Figure 1, 2). Decrease in inequities were noted most significantly in the Hispanic population (101 min to 77 min; 35% improvement compared to 17%). Total order set usage (0 to 83%) and critical information note placement increased (from 0 to 78%) without a shift in our balance measure.
Conclusion: Although we did not achieve our goal, we improved the variability and percentage of febrile oncology patients receiving antibiotics < 60 min and saw decreases in inequities. The most impactful intervention was having nurses order antibiotics, since they have first contact with patients, and sustainability was achieved by providing MOC physician credit with monthly data review.
