Making Improvements in the ED

Abstract

Implementation of a CPG and process improvements significantly reduced median TTA administration. Total patient arrivals per hour as a proxy of ED crowding did not affect TTA administration. Our data suggest that positive improvements in clinical care can be successful despite fluctuations in ED patient volume.

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

“…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%).…”

“…Safety Most studies were underpowered to address safety (mortality, ICU admission, or occurrence of severe sepsis). Number of deaths was reported by eleven studies [16,24,25,31,33,35,36,39,42,43,46], with a median mortality of 0% (maximum 39%) before and median mortality of 0% (maximum 6%) after the intervention. No significant differences of mortality before and after intervention were detected in seven of these 11 studies.…”

“…In their study, ICU admission and septic shock were as well significantly reduced after the implementation, 9.4 to 2.9% (p = 0.016) and 10.9 to 3.5% (p = 0.011), respectively. Numbers of ICU admissions were reported by eight studies [24,25,33,35,36,39,42,46], with a median of 5% (maximum 9%) before and a median of 1.3% (maximum 7%) after the intervention. Only one study [16] found a difference in need for ICU admission before and after the intervention (34% versus 12.8%; p < 0.05).…”

“…For length of hospital stay (LOS), five studies [24,25,27,29,33] did not find a significant difference before and after the intervention. In one of those studies [24], LOS was reduced after an intervention when compared with a historical cohort in a multivariable analysis that adjusted for age, disease type, MASCC risk index, prophylactic antibiotics, central line, and ANC, but not in univariate analysis.…”

Effect of Prearrival Orders on Time to Antibiotics for Immunocompromised Oncology Patients Presenting to the Emergency Department With Fever

“…[12][13][14] There are a number of published studies highlighting efforts to reduce the time to antibiotics for febrile pediatric oncology patients. These efforts have taken place in oncology clinics or infusion centers, 15 oncology wards, 16 emergency departments (EDs), 3,5,[17][18][19][20][21][22][23][24][25][26][27] or in some cases, a combination of these locations. 28 Most efforts have been pursued as quality improvement initiatives using LEAN or other quality improvement tools focused on the analysis of the steps involved in the process of evaluation and treatment of these patients.…”