title: Clinical Pathway Effectiveness: Febrile Young Infant Clinical Pathway in a Pediatric Emergency Department.
abstract: OBJECTIVE
  Young infants are often treated in emergency departments (EDs) for febrile illnesses. Any delay in care or ineffective management could lead to increased patient morbidity and mortality. A standardized ED clinical pathway may improve care for these patients. The objective of this study is to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care.
  
  
  METHODS
  This study used a before-and-after retrospective observational study design comparing 2 separate periods: prepathway from September 2007 through August 2008 and postpathway from September 2009 through August 2010. Subjects were infants aged 56 days or younger presenting with a rectal temperature of 38.0°C or higher. Patients were excluded if they were transferred from another hospital or if they developed a fever after initial presentation.
  
  
  RESULTS
  Five hundred twenty infants were enrolled. The mean time to urine collection and time to the first antibiotic administration were reduced after pathway implementation (23-minute reduction to urine collection vs 36-minute reduction to the first antibiotic administration). There was improvement in the proportion of infants who received the pathway-specific antibiotics based on age (odds ratio, 7.2; 95% confidence interval, 4.4, 11.9) and the proportion of infants who were administered acyclovir based on pathway guidelines (odds ratio, 8.8; 95% confidence interval, 2.9-30.0).
  
  
  CONCLUSIONS
  An ED-based febrile young infant clinical pathway improved the timeliness of initiation of work-up as measured by urine collection and of therapy by an earlier administration of the first antibiotic, as well as decreased variability of care.
authors.affiliation: From the *The Children's Hospital of Philadelphia, Philadelphia, PA; and †Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Ashlee Lynn
authors.initials: AL
authors.lastname: Murray
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Alpern
authors.forename: Jane
authors.initials: J
authors.lastname: Lavelle
authors.forename: Cynthia
authors.initials: C
authors.lastname: Mollen
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019091:Critical Pathways / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011787:Quality of Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D059349:Urine Specimen Collection / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents