Clinical Practice Guideline Reduces Evaluation and Treatment for Febrile Infants 0 to 56 Days of Age

Abstract

Invasive bacterial infection (IBI) is associated with significant morbidity and mortality among neonates. Clinical practice guidelines (CPGs) can expedite care and standardize management. We conducted a retrospective observational study of febrile infants aged 0 to 56 days to assess changes in clinical decision-making following febrile neonate CPG implementation in the pediatric emergency department of a tertiary care hospital. Data were reviewed pre- and post-CPG implementation, with 1-year separation for provider education. Fewer infants underwent laboratory testing (complete blood count, blood culture, urine culture, lumbar puncture), antibiotic administration, and hospital admission after implementation; the greatest decrease was observed among infants aged 29 to 56 days identified as not high risk for meningitis. Seven-day IBI readmission rate was 1% in both groups. Herpes simplex virus testing and treatment did not differ significantly between groups. These results suggest that CPGs can enable both standardized care and decreased intervention in this population with no change in 7-day readmission rates.

Interventions to reduce acute paediatric hospital admissions: a systematic review

“…Of the seven papers included in the previous review, two were included in the present review 15,30 , three were published prior to 2000, one was published French and one did not meet inclusion criteria. Nineteen studies 9,10, 16,17,21,23,24,26,27,[31][32][33][34][35][36][37][38][39][40] were published after the search in the previous review. 11…”

“…Thirteen studies were from North America, 16,17,23,24,26,[28][29][30][34][35][36][37]39 eight from Europe, 9,10,15,21,22,31,32,38 six from Australia, 18,20,25,27,40,41 and one from Asia. 33 Nineteen studies had a before-and-after design and four 22,32,33,35 compared non-randomised assessment options within the same period.…”

“…The earliest studies began in 18,29 and the latest in 2017; 36 seven studies began between 1990-1999, 15,18,25,29,30 ten between 2000-2009 10,16,17,[22][23][24]28,31,35,38 and eleven after 2009. 9, 21,26,27,[32][33][34]36,37,39,40…”

“…Hospital admission was reported in studies, 9,10,15,16,[18][19][20]22,23,[25][26][27][28][29][30][31][32][34][35][36][38][39][40] readmission in nine, 17,[19][20][21]24,26,39 and length of stay in 15 studies. 10,16,[18][19][20][21]23,24,[26][27][28][29][30]36,37 The primary outcome was presented as odds ratio (OR) or relative risk (RR) of hospital admission [15][16][17]22,32,34,35...…”

Simulation in Pediatrics: A Learning Lab for Education, Quality Improvement, and Patient Safety

“…For example, with the advancements in noninvasive ventilation and surfactant administration, fewer neonates require intubation in the delivery room 1 and with each successive guideline review, fewer infants must undergo lumbar puncture in the setting of fever. 2 Regardless, when high stakes, low volume interventions are needed, we must be prepared to perform them well.…”