Improving Time to Antibiotics for Pediatric Oncology Patients With Suspected Infections

Yoshida, Hiromi; Leger, Kasey J.; Xu, Min Li; Migita, Russell; Rutledge, Joe C.; Pollard, Jessica A.; Kroon, Leah; Mazor, Suzan; Moon, Andres; Rutman, Lori

doi:10.1097/pec.0000000000001367

Cited by 15 publications

(15 citation statements)

References 12 publications

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“…This study was also limited by dependence on laboratory technology that may not be widely available. The rapid ANC, which considerably decreases laboratory turnaround time, supports the practice of initial observation by allowing practitioners to administer antibiotics within the recommended hour if the patient is indeed neutropenic.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Muller

Morgan

2018

Pediatric Blood & Cancer

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There are no consensus guidelines for management of pediatric oncology patients presenting with fever and nonneutropenia, with limited research into the outcomes of withholding empiric i.v. antibiotics. We conducted a prospective cohort study assessing the safety and efficacy of observing well‐appearing patients presenting with fever and nonneutropenia (absolute neutrophil count ≥ 500 cells/mm3). Of 238 episodes, 82.7% patients were observed with no infectious complications and low overall incidence of bacteremia (3.4%). There were no significant differences in individual clinical variables. We propose that observation alone in some well‐appearing febrile pediatric oncology patients is safe and limits the use of unnecessary empiric antibiotics.

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Section: Discussionmentioning

confidence: 99%

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Muller

Morgan

2018

Pediatric Blood & Cancer

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“…High workload due to high patient volumes and lack of training in care of oncology patients may explain this. Three included studies [26,34,47] mentioned ED overcrowding and lack of staff as a barrier to changes; these are factors difficult to address by physicians but should be acknowledged by institutions, where identified.…”

Section: Discussionmentioning

confidence: 99%

“…1. Thirty studies were included, thirteen in adult [12,[20][21][22][23][24][25][26][27][28][29][30][31], and seventeen in pediatric patients [16,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47], including a total of 1891 and 6820 FN episodes, respectively. Two-third of the studies were undertaken in the USA (n = 20; 67%).…”

Section: Overviewmentioning

confidence: 99%

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

Koenig

Schneider

Morgan

et al. 2019

Support Care Cancer

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Purpose Multiple interventions have been developed aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia (FN) following chemotherapy for cancer. We evaluated their effect to reduce TTA and their impact on important clinical outcomes in a systematic review. Methods The search covered seven databases. Biases and quality of studies were assessed with the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Interventions could be implemented in any setting and performed by any person included in the FN management. Absolute change of TTA was the primary outcome. Registration: PROSPERO (CRD42018092948). Results Six thousand two hundred ninety-six titles and abstracts were screened, 177 studies were retrieved and 30 studies were included. Risk of bias was moderate to serious in 28 studies and low in two studies. All but one study reported a reduction of TTA after the intervention. Various types of interventions were implemented; they most commonly aimed at professionals. Most of the studies made more than one single intervention. Conclusion This review may help centers to identify their specific sources of delay and barriers to change and to define what intervention may be the best to apply. This review supports the assertion that TTA can be considered a measure of quality of care, emphasizes the importance of education and training, and describes the very different interventions which have effectively reduced TTA.

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“…18 Likewise, Yoshida et al trialed a rapid laboratory test for ANC with good results. 19 This project employed a novel technology, in a secure text-messaging platform, to drive improvement. Also, this project demonstrates a rapid-cycle PDSA approach to rebuilding the entire flow of a clinical process of care.…”

Section: Discussionmentioning

confidence: 99%

An Initiative to Decrease Time to Antibiotics for Patients With Fever and Neutropenia

et al. 2018

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The objective was to decrease the time to antibiotic administration for patients arriving in the pediatric emergency department with fever and neutropenia. A multidisciplinary team was assembled and engaged in process analysis through interviews and data review. These findings were used to develop key drivers, and Pareto charts were utilized to prioritize interventions. Interventions were tested and implemented using rapid Plan-Do-Study-Act cycles. Progress was monitored using process control charts. Interventions included leveraging a secure text-based messaging platform, creating a new antibiotic pathway, and educating staff and family. Between September 2016 and September 2017, the average time to antibiotics was decreased from 116 to 55 minutes in this population. This also was associated with a decrease in variation (individual moving range mean decreased from 43 minutes to 18 minutes). Careful process analysis, coupled with the work of a multidisciplinary team, produced significant improvements in efficiency of care for these vulnerable patients.

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Improving Time to Antibiotics for Pediatric Oncology Patients With Suspected Infections

Abstract: 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.

Cited by 15 publications

References 12 publications

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Outcomes of observation without empiric intravenous antibiotics in febrile, nonneutropenic pediatric oncology patients

Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review

An Initiative to Decrease Time to Antibiotics for Patients With Fever and Neutropenia

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