Abstract 19 Timeliness to Antibiotics in Pediatric Short Bowel Syndrome Patients With Central Line and Fever in the Emergency Department

Abstract

Background: Short bowel syndrome (SBS) patients have a higher rate of central line associated bloodstream infection (CLABSI) than patients without intestinal failure (7.8 vs 1.3 per 1000 catheter days). SBS patients have a high incidence of gram-negative bacteremia, which is known to carry a high rate of morbidity and mortality. Prompt administration of antibiotics is crucial for successful management of patients with central line and fever. AIM: To decrease the time to antibiotics in SBS patients with central line and fever in the emergency department (ED) by 50 % by December of 2016. Methods: The setting was an academic ED at an urban quaternary center that sees ∼60,000 children annually. We did a retrospective chart review of all SBS patients with central lines between April 2014 and July 2015, and collected demographics data, time to antibiotics when presenting to the ED with a fever, and blood culture results. In August 2015, we assembled a multidisciplinary quality improvement (QI) team, determined key drivers and intervention steps, and implemented changes to decrease the time to antibiotics in SBS patients with central line and fever in the ED. Interventions included education of ED staff, creation of “Fast Pass” wallet cards for families, creation of an EPIC © order set, and communication with pharmacy. Monthly average time to antibiotics was tracked and outcomes were presented using a run chart with pre-intervention and postintervention data. The median time to antibiotics in the pre and post-intervention periods was analyzed using a Wilcoxon Rank Sum Test. Results: In total, there were 51 admissions for fever in 12 SBS patients with central lines (19 admissions in the pre-intervention period, and 32 admissions in the post-intervention period). In the pre-intervention period, 32% of blood cultures were positive, of which 50% were due to gram negative bacteria. In the postintervention period, 50% of blood cultures were positive, of which 50% were due to gram negative bacteria. The median time to antibiotics decreased by 41% following implementation of a QI team from 213 minutes (IQR: 159-239 min) pre-intervention to 126 minutes (IQR: 110-195 min) post-intervention (p=0.04). Conclusions: Forming a multidisciplinary QI team led to a 41% reduction in time to antibiotics for SBS patients with central line and fever. New interventions continue to take place, and efforts continue to drive the time to antibiotics lower and assess the sustainability of these changes. Future studies are needed to determine whether the improvement in time to antibiotics will lead to fewer admissions to the intensive care unit, shorter hospitalizations, and decreased rates of central line removal.