Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington.
Division of Informatics and Health Systems Sciences, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.
Pediatrics. 2024 May 1;153(5). doi: 10.1542/peds.2023-063339.
We aimed to examine the impact of a quality improvement (QI) collaborative on adherence to specific recommendations within the American Academy of Pediatrics' Clinical Practice Guideline (CPG) for well-appearing febrile infants aged 8 to 60 days.
Concurrent with CPG release in August 2021, we initiated a QI collaborative involving 103 general and children's hospitals across the United States and Canada. We developed a multifaceted intervention bundle to improve adherence to CPG recommendations for 4 primary measures and 4 secondary measures, while tracking 5 balancing measures. Primary measures focused on guideline recommendations where deimplementation strategies were indicated. We analyzed data using statistical process control (SPC) with baseline and project enrollment from November 2020 to October 2021 and the intervention from November 2021 to October 2022.
Within the final analysis, there were 17 708 infants included. SPC demonstrated improvement across primary and secondary measures. Specifically, the primary measures of appropriately not obtaining cerebrospinal fluid in qualifying infants and appropriately not administering antibiotics had the highest adherence at the end of the collaborative (92.4% and 90.0% respectively). Secondary measures on parent engagement for emergency department discharge of infants 22 to 28 days and oral antibiotics for infants 29 to 60 days with positive urinalyses demonstrated the greatest changes with collaborative-wide improvements of 16.0% and 20.4% respectively. Balancing measures showed no change in missed invasive bacterial infections.
A QI collaborative with a multifaceted intervention bundle was associated with improvements in adherence to several recommendations from the AAP CPG for febrile infants.
我们旨在研究质量改进（QI）合作对遵守美国儿科学会（AAP）临床实践指南（CPG）中针对 8 至 60 天外观良好发热婴儿的特定建议的影响。
在 2021 年 8 月 CPG 发布的同时，我们在美国和加拿大的 103 家综合医院和儿童医院开展了一项 QI 合作。我们制定了一个多方面的干预措施包，以提高对 4 项主要措施和 4 项次要措施的 CPG 建议的遵守率，同时跟踪 5 项平衡措施。主要措施侧重于指南建议中需要去执行策略的地方。我们使用统计过程控制（SPC）分析数据，基线和项目登记时间为 2020 年 11 月至 2021 年 10 月，干预时间为 2021 年 11 月至 2022 年 10 月。
在最终分析中，共有 17708 名婴儿纳入研究。SPC 显示主要和次要措施都有所改善。具体而言，在合作结束时，主要措施中适当不对符合条件的婴儿进行腰椎穿刺和适当不给予抗生素的措施的遵守率最高（分别为 92.4%和 90.0%）。对于 22 至 28 天龄婴儿的急诊科出院时家长参与度和对于阳性尿液分析的 29 至 60 天龄婴儿给予口服抗生素的二级措施显示出最大的变化，分别为合作范围内的改善了 16.0%和 20.4%。平衡措施显示未发生漏诊的侵袭性细菌感染。
具有多方面干预措施包的 QI 合作与遵守 AAP CPG 中针对发热婴儿的几项建议有关。
