Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative

Dandoy, Christopher E.; Hariharan, Selena; Weiss, Brian; Demmel, Kathy; Timm, Nathan; Chiarenzelli, Janis; Dewald, Mary; Kennebeck, Stephanie; Langworthy, Shawna; Pomales, Jennifer; Rineair, Sylvia A.; Sandfoss, Erin Lynn; Volz-Noe, Pamela; Nagarajan, Rajaram; Alessandrini, Evaline A.

doi:10.1136/bmjqs-2015-004451

Cited by 24 publications

(29 citation statements)

References 23 publications

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“…These advances in childhood ALL survival have spanned all age groups, races, and both sexes . Clinicians have had increased success with managing the frequent complications of ALL, including tumor lysis syndrome, infection during neutropenia, thrombosis, hemorrhage, anaphylaxis, and suppression of the hypothalamic‐pituitary‐adrenal axis . In addition, intrathecal therapy has been used increasingly instead of cranial irradiation for patients with central nervous system disease, thereby reducing radiation‐associated morbidity and mortality .…”

Section: Discussionmentioning

confidence: 99%

“…36 Clinicians have had increased success with managing the frequent complications of ALL, including tumor lysis syndrome, infection during neutropenia, thrombosis, hemorrhage, anaphylaxis, and suppression of the hypothalamic-pituitaryadrenal axis. [39][40][41] In addition, intrathecal therapy has been used increasingly instead of cranial irradiation for patients with central nervous system disease, thereby reducing radiation-associated morbidity and mortality. 33,42 There has been increasing use of immunophenotyping and cytogenetic characterization to predict outcome and relapse and thus to guide risk-based adjustments in therapy.…”

Section: Clinical Perspectivementioning

confidence: 99%

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Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD‐2 study

Tai

Ward

Bonaventure

et al. 2017

Cancer

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BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. This report describes the survival of children with ALL in the United States using the most comprehensive and up-to-date cancer registry data. METHODS: Data from 37 state cancer registries that cover approximately 80% of the US population were used. Age-standardized survival up to 5 years was estimated for children aged 0–14 years who were diagnosed with ALL during 2 periods (2001–2003 and 2004–2009). RESULTS: In total, 17,500 children with ALL were included. The pooled age-standardized net survival estimates for all US registries combined were 95% at 1 year, 90% at 3 years, and 86% at 5 years for children diagnosed during 2001–2003, and 96%, 91%, and 88%, respectively, for those diagnosed during 2004–2009. Black children who were diagnosed during 2001–2003 had lower 5-year survival (84%) than white children (87%) and had less improvement in survival by 2004–2009. For those diagnosed during 2004–2009, the 1-year and 5- year survival estimates were 96% and 89%, respectively, for white children and 96% and 84%, respectively, for black children. During 2004–2009, survival was highest among children aged 1 to 4 years (95%) and lowest among children aged <1 year (60%). CONCLUSIONS: The current results indicate that overall net survival from childhood ALL in the United States is high, but disparities by race still exist, especially beyond the first year after diagnosis. Clinical and public health strategies are needed to improve health care access, clinical trial enrollment, treatment, and survivorship care for children with ALL.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspectivementioning

confidence: 99%

Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD‐2 study

Tai

Ward

Bonaventure

et al. 2017

Cancer

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“…We defined "timely antibiotic administration" as antibiotics being given within 60 minutes from the time of fever, which was based on the definitions provided in previous studies. 16,23 The percentage of patients receiving antibiotics within 60 minutes was managed through a p-chart. We measured 10 consecutive patients in the control charts secondary to the extreme variability in the number of new fevers each month.…”

Section: Evaluation and Analysismentioning

confidence: 99%

Improving Time to Antibiotic Administration for Bone Marrow Transplant Patients With First Fever

et al. 2018

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“… 11 , 12 In 2016, members of this team successfully utilized quality improvement (QI) methodology to decrease time to antibiotics (TTA) in febrile immunocompromised (F&I) oncology/bone marrow transplant patients. 13 Using prearrival notification, family engagement, and standardized ED postarrival processes, over 90% of F&I patients received antibiotics within 60 minutes. 13 …”

Section: Introductionmentioning

confidence: 99%

“… 13 Using prearrival notification, family engagement, and standardized ED postarrival processes, over 90% of F&I patients received antibiotics within 60 minutes. 13 …”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Initiative to Decrease Time to Antibiotics for Children with Intestinal Failure, Fever, and a Central Line

Hariharan

Mezoff

Dandoy

et al. 2018

Pediatric Quality &Amp; Safety

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Introduction:Pediatric intestinal failure (IF) patients experience significant morbidity, including sepsis related to central line–associated bloodstream infections. Adult studies of sepsis demonstrate an association between time to antibiotic administration (TTA) and mortality. To overcome challenges in treating pediatric IF patients in an emergency department (ED), we appropriated an existing, reliable system for febrile immunocompromised oncology/bone marrow transplant children. We describe the translation of this process to febrile IF patients in the ED and steps toward sustained improvement.Methods:We formed a multidisciplinary team and used the Model for Improvement to define aims and identify key drivers. The goal was to use an existing improvement process to increase the percentage of patients with IF who receive antibiotics within 60 minutes of arrival to the ED from 46% to 90%. Key drivers included pre- and postarrival processes, staff and family engagement, and a preoccupation with failure. We performed Plan-Do-Study-Act cycles targeting family engagement, prearrival efficiency, and postarrival consistency.Results:Two hundred seventy-six encounters involving febrile IF patients between November 2012 and March 2017 were evaluated. There was a sustained reduction in the median time from arrival to antibiotic administration (71–45 minutes). We decreased TTA to less than 60 minutes for 77% of febrile IF patients.Conclusions:The basic tenets of process improvement for 1 high-risk population can be translated to another high-risk population but must be adjusted for variability in characteristics.

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Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative

Abstract: This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients.

Cited by 24 publications

References 23 publications

Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD‐2 study

Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD‐2 study

Improving Time to Antibiotic Administration for Bone Marrow Transplant Patients With First Fever

A Quality Improvement Initiative to Decrease Time to Antibiotics for Children with Intestinal Failure, Fever, and a Central Line

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