Foster Lauren Z, Beiner Joshua, Duh-Leong Carol, Mascho Kira, Giordani Victoria, Rinke Michael L, Trasande Leonardo, Wiener Ethan, Rosenberg Rebecca E
Department of Pediatrics, New York University School of Medicine, Hassenfeld Children's Hospital at NYU Langone, New York City, N.Y.
Department of Pediatrics, Children's Hospital at Montefiore, New York City, N.Y.
Pediatr Qual Saf. 2020 Jan 22;5(1):e252. doi: 10.1097/pq9.0000000000000252. eCollection 2020 Jan-Feb.
The clinical management of well-appearing febrile infants 7-60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG).
The Model for Improvement was used to implement a CPG for the management of well-appearing febrile infants, with collaboration between pediatric emergency medicine and pediatric hospital medicine physicians. Interventions included physician education, process audit/feedback, and development of an electronic orderset. We used statistical process control charts to assess the primary aims of appropriate risk stratification and length of stay.
Over a 34-month period, 168 unique encounters (baseline n = 65, intervention n = 103) were included. There was strong adherence for appropriate risk stratification in both periods: the proportion of low-risk patients admitted inappropriately decreased from 14.8% to 10.8%. Among admitted high-risk patients, the mean length of stay decreased from 49.4 to 38.2 hours, sustained for 18 months.
CPG implementation using quality improvement methodology can increase the delivery of evidence-based care for febrile infants, leading to a reduction in length of stay for high-risk infants.
7至60日龄外观良好的发热婴儿的临床管理仍存在差异，部分原因是区分严重细菌感染风险的标准众多。本质量改进研究的目的是通过实施循证临床实践指南（CPG），规范急诊科的风险分层及住院部的住院时长。
采用改进模型实施针对外观良好的发热婴儿管理的CPG，由儿科急诊医学和儿科医院医学医生合作进行。干预措施包括医生教育、流程审核/反馈以及电子医嘱集的开发。我们使用统计过程控制图来评估适当风险分层和住院时长的主要目标。
在34个月的时间里，纳入了168次独特的诊疗（基线期n = 65，干预期n = 103）。两个时期对适当风险分层的依从性都很高：不适当收治的低风险患者比例从14.8%降至10.8%。在收治的高风险患者中，平均住院时长从49.4小时降至38.2小时，并持续了18个月。
采用质量改进方法实施CPG可增加对发热婴儿的循证护理，从而缩短高风险婴儿的住院时长。
