title: Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs.
abstract: BACKGROUND
  Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N.
  
  
  METHODS
  We used Lean-Methodology and a Plan-Do-Study-Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub-process times, and clinical outcomes.
  
  
  RESULTS
  Our QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60 min nearly 100% of the time. All TTA sub-process times also improved. Moreover, achieving TTA <60 min significantly reduced the need for ICU consultation or admission (P = 0.003) in this population.
  
  
  CONCLUSIONS
  Here we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60 min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N.
authors: Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado; Department of Biochemistry and Molecular Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado.
authors: Jennifer L
authors: JL
authors: Salstrom
authors: Rebecca L
authors: RL
authors: Coughlin
authors: Kathleen
authors: K
authors: Pool
authors: Melissa
authors: M
authors: Bojan
authors: Camille
authors: C
authors: Mediavilla
authors: William
authors: W
authors: Schwent
authors: Michael
authors: M
authors: Rannie
authors: Dawn
authors: D
authors: Law
authors: Michelle
authors: M
authors: Finnerty
authors: Joanne
authors: J
authors: Hilden
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology; D010372:Pediatrics; D011379:Prognosis; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics time; fever; neutropenia; quality improvement