title: Effect of a quality improvement intervention to decrease delays in antibiotic delivery in pediatric febrile neutropenia: a pilot study.
abstract: OBJECTIVE
  Guidelines recommend the early (less than 1 hour) initiation of antibiotics for patients with severe sepsis. We hypothesize that a simple quality improvement intervention, leaving the first dose of broad-spectrum antibiotics available in the emergency cart, decreases the time to delivery of antibiotics and reduces medical complications in pediatric oncologic patients with febrile neutropenia.
  
  
  METHODS
  Before and after observation of time to antibiotic delivery. The study population included patients (age ≤18 years) undergoing chemotherapy who were admitted in a pediatric intensive care unit with fever related to an infection as a major diagnostic category. Twenty-five patient charts were reviewed for each period. Data were retrospectively collected with a standardized form.
  
  
  RESULTS
  Time to antibiotic delivery was significantly reduced in the post-intervention period, from a median 164 minutes (interquartile range, 108-172 minutes) to a median 55 minutes (interquartile range, 18-225 minutes). The proportion of patients receiving antibiotics in less than 60 minutes increased from 0% (95% confidence interval, 0%-14%) in the preintervention period to 52% (95% confidence interval, 30%-74%; P < .001) in the post-intervention period. Complication rates were low during both periods.
  
  
  CONCLUSIONS
  Our results suggest that simple interventions can reduce time to antibiotic administration in a selected group of patients in a pediatric intensive care unit.
authors.affiliation: Department of Internal Medicine, University of Brasília, Brasília, DF, Brazil 70910.
authors.forename: Veronica Moreira
authors.initials: VM
authors.lastname: Amado
authors.forename: Guilherme Pinho
authors.initials: GP
authors.lastname: Vilela
authors.forename: Abdias
authors.initials: A
authors.lastname: Queiroz
authors.forename: André Carlos Kajdacsy-Balla
authors.initials: AC
authors.lastname: Amaral
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy*; D010865:Pilot Projects; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents