Pediatric Resident Baystate Children's Hospital Holyoke, Massachusetts, United States
Background: Fever is one of the most common presenting symptoms in infants, yet only a small subset of well-appearing febrile infants will have a serious bacterial infection. The 2021 AAP Clinical Practice Guideline (CPG) on management of these infants addresses changing bacteriology, advances in testing, updated risk stratification, and avoidance of unnecessary care. However, many barriers have been identified that impede the translation of national guidelines into practice, and less is known about the impact of the CPG on local practice Objective: The aim of this QI project is to 1) develop and implement a local institutional clinical pathway for the management of well-appearing febrile infants; and 2) to assess the extent to which adherence to the updated CPG improves over time following the CPG publication compared to subsequent local Clinical Pathway implementation efforts. Design/Methods: Via retrospective and prospective chart review we will identify infants presenting to the emergency room with fever that did not meet CPG exclusion criteria. This QI initiative was reviewed by the Baystate Health IRB and did not meet the criteria for human subjects research. Applying standard control chart rules to denote special cause variation, we will first compare the management of febrile infants presenting to Baystate Children’s Hospital (BCH) from May 2019 to August 2021 (before CPG release) with those presenting between September 2021 and October 2023. Outcome measures include admission rate and adherence to clinical guideline recommendations for lumbar puncture, procalcitonin measurement, and antibiotic administration. Missed serious bacterial infection will be a balancing measure. Using a QI approach, we will then monitor changes in the care of well-appearing febrile infants at BCH between November 2023 and February 2024 following implementation of a BCH-specific clinical pathway in November 2023. Implementation will be supported by strategies to support the Pathman model of Awareness, Agreement, Adoption, and Adherence.
