Yoshida Hiromi, Leger Kasey J, Xu Min, Migita Russell T, Rutledge Joe C, Pollard Jessica A, Kroon Leah, Mazor Suzan S, Moon Andres, Rutman Lori E
Pediatr Emerg Care. 2018 Jan;34(1):47-52. doi: 10.1097/PEC.0000000000001367.
Studies in pediatric patients with fever and neutropenia demonstrate that shorter time to antibiotics is associated with a decrease in pediatric intensive care unit admissions and in-hospital mortality. In 2012, a 2-phase quality improvement intervention was implemented in a pediatric emergency department (ED) to improve care for this high-risk patient population.The objective was to determine if the introduction of (1) a rapid absolute neutrophil count (ANC) test and (2) a standardized prearrival process decreased time to antibiotics for febrile hematology/oncology(heme/onc) patients presenting to the ED.
The rapid ANC test introduced in February 2012 decreased turn-around-times in the laboratory from 60 to 10 minutes. The standardization of the prearrival communication between the heme/onc team and ED was implemented in August 2012 as part of a clinical standard work pathway for heme/onc patients who presented to the ED with fever and possible neutropenia. Time from arrival to the ED to administration of first antibiotic was measured.Data from January 2011 to December 2013 were analyzed using statistical process control.
Seven hundred eighteen encounters for 327 patients were included. After the rapid ANC test, the proportion of patients who received antibiotics within 60 minutes of arrival increased from 47% to 60%. There was further improvement to 69% with implementation of the clinical standard work pathway. Mean time to antibiotics decreased from 83 to 65 minutes (21% decrease).
This 2-phase quality improvement intervention increased the proportion of patients who received antibiotics within 60 minutes of arrival to the ED. Similar processes may be implemented in other pediatric EDs to improve timeliness of antibiotic administration.
针对小儿发热伴中性粒细胞减少症患者的研究表明，缩短使用抗生素的时间与减少儿科重症监护病房收治率及住院死亡率相关。2012年，一家儿科急诊科实施了一项两阶段质量改进干预措施，以改善对这一高危患者群体的护理。目的是确定引入（1）快速绝对中性粒细胞计数（ANC）检测和（2）标准化的到达前流程是否能缩短急诊科收治的发热血液学/肿瘤学（血液/肿瘤）患者使用抗生素的时间。
2012年2月引入的快速ANC检测将实验室周转时间从60分钟缩短至10分钟。血液/肿瘤团队与急诊科之间到达前沟通的标准化于2012年8月实施，作为针对因发热和可能的中性粒细胞减少症就诊于急诊科的血液/肿瘤患者的临床标准工作流程的一部分。测量从到达急诊科到首次使用抗生素的时间。使用统计过程控制分析2011年1月至2013年12月的数据。
纳入了327例患者的718次就诊情况。快速ANC检测后，到达后60分钟内接受抗生素治疗的患者比例从47%增至60%。实施临床标准工作流程后进一步提高至69%。使用抗生素的平均时间从83分钟降至65分钟（减少21%）。
这一两阶段质量改进干预措施提高了到达急诊科后60分钟内接受抗生素治疗的患者比例。其他儿科急诊科可实施类似流程以提高抗生素给药的及时性。
