Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City.
Pediatr Emerg Care. 2021 Jan 1;37(1):e25-e31. doi: 10.1097/PEC.0000000000002012.
Management of febrile infants 60 days and younger for suspected serious infection varies widely. Clinical practice guidelines (CPGs) are intended to improve clinician adherence to evidence-based practices. In 2011, a CPG for managing febrile infants was implemented in an urban children's hospital with simultaneous release of an electronic order set and algorithm to guide clinician decisions for managing infants for suspected serious bacterial infection. The objective of the present study was to determine the association of CPG implementation with order set use, clinical practices, and clinical outcomes.
Records of febrile infants 60 days and younger from February 1, 2009, to January 31, 2013, were retrospectively reviewed. Clinical documentation, order set use, clinical management practices, and outcomes were compared pre-CPG and post-CPG release.
In total, 1037 infants pre-CPG and 930 infants post-CPG implementation were identified. After CPG release, more infants 29 to 60 days old underwent lumbar puncture (56% vs 62%, P = 0.02). Overall antibiotic use and duration of antibiotic use decreased for infants 29 to 60 days (57% vs 51%, P = 0.02). Blood culture and urine culture obtainment remained unchanged for older infants. Diagnosed infections, hospital readmissions, and length of stay were unchanged. Electronic order sets were used in 80% of patient encounters.
Antibiotic use and lumbar puncture performance modestly changed in accordance with CPG recommendations provided in the electronic order set and algorithm, suggesting that the presence of embedded prompts may affect clinician decision-making. Our results highlight the potential usefulness of these decision aids to improve adherence to CPG recommendations.
60 天及 60 天以下发热婴儿疑似严重感染的处理方法差异较大。临床实践指南（CPG）旨在提高临床医生对循证实践的依从性。2011 年，某城市儿童医院实施了一项管理发热婴儿的 CPG，同时发布了电子医嘱单和算法，以指导临床医生对疑似严重细菌感染婴儿的处理决策。本研究的目的是确定 CPG 实施与医嘱单使用、临床实践和临床结局之间的关系。
回顾性分析 2009 年 2 月 1 日至 2013 年 1 月 31 日 60 天及 60 天以下发热婴儿的病历。比较 CPG 实施前后的临床记录、医嘱单使用、临床管理实践和结局。
共纳入 1037 例 CPG 实施前和 930 例 CPG 实施后婴儿。CPG 发布后，2960 天龄婴儿行腰椎穿刺的比例增加（56%比 62%，P=0.02）。2960 天龄婴儿抗生素使用率和使用时间均降低（57%比 51%，P=0.02）。年长婴儿的血培养和尿培养无变化。确诊感染、住院再入院和住院时间无变化。电子医嘱单在 80%的患者就诊中使用。
电子医嘱单和算法中嵌入的提示可能会影响临床医生的决策，从而使抗生素使用和腰椎穿刺操作符合 CPG 推荐。本研究结果突出了这些决策辅助工具在提高 CPG 推荐依从性方面的潜在作用。
