title: Predictors of wait-time for antibiotic initiation and association of wait-time with hospital length of stay and ICU admission among children with cancer at the Southern Philippines Medical Center.
abstract: BACKGROUND
  Expedited antibiotic administration improves the survival of children with cancer and infection. A 1-hour antibiotic wait-time (AWT) post-hospital arrival is a quality-of-care bench mark in healthcare. However, multiple factors preclude achieving this goal in developing countries. Predictors of AWT and its association with hospital length of stay (LOS) and intensive care unit (ICU) admission at the Southern Philippines Medical Center (SPMC) were identified.
  
  
  METHODS
  Health and socioeconomic characteristics of 55 children in 92 admissions who required antibiotics were reviewed;and SPMC care providers about institutional capacity and response to suspected infection were surveyed.
  
  
  RESULTS
  The mean total AWT was 3 days and 15 hours. For admissions of established patients, mean total AWT and mean LOS were approximately half that for new patients. Admissions from high-income households waited an average 44% less for antibiotics and were discharged 43% sooner than those from medium-income households. Admissions from residence owner families waited 31% less to receive antibiotics, and total AWT for admissions of patients with no insurance was 32% less than for those with insurance. The likelihood of ICU admission increased 20% with every 1-day increase in total AWT (95% CI: 1.021.42). Only 59% of nurses recognized fever as an emergency.
  
  
  CONCLUSIONS
  AWT is complex and multifactorial; it may be reduced by educating parents and care providers about infection and infection control and improving the availability of antibiotics and associated supplies. These interventions will most likely reduce ICU admissions and possibly LOS and increase the survival of pediatric oncology patients at SPMC.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Kirby
authors.forename: Mae
authors.initials: M
authors.lastname: Dolendo
authors.forename: Don
authors.initials: D
authors.lastname: Guimera
authors.forename: Czarina
authors.initials: C
authors.lastname: Castillo
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Johnson
authors.forename: Fawaz
authors.initials: F
authors.lastname: Mzayek
authors.forename: Vikki G
authors.initials: VG
authors.lastname: Nolan
authors.forename: George
authors.initials: G
authors.lastname: Relyea
authors.forename: Miguela A
authors.initials: MA
authors.lastname: Caniza
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents