Eric A Biondi1, Russell McCulloh2, Vincent S Staggs3,4, Matthew Garber5, Matt Hall6, Julia Arana7, Benj Barsotti8, Beth C Natt9, Alan R Schroeder10, Lisa Schroeder3, Todd Wylie5, Shawn L Ralston11. 1. Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland; ebiondi2@jhmi.edu. 2. Children's Hospital and Medical Center, Omaha, Nebraska. 3. Children's Mercy Hospital, Kansas City, Missouri. 4. University of Missouri-Kansas City, Kansas City, Missouri. 5. College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida. 6. Children's Hospital Association, Overland Park, Kansas. 7. East Tennessee Children's Hospital, Knoxville, Tennessee. 8. Virginia Mason Memorial Hospital, Yakima, Washington. 9. Connecticut Children's Medical Center, Hartford, Connecticut. 10. Department of Pediatrics, School of Medicine, Stanford University, Stanford, California; and. 11. Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire.
Abstract
BACKGROUND: Substantial variability exists in the care of febrile, well-appearing infants. We aimed to assess the impact of a national quality initiative on appropriate hospitalization and length of stay (LOS) in this population. METHODS: The initiative, entitled Reducing Variability in the Infant Sepsis Evaluation (REVISE), was designed to standardize care for well-appearing infants ages 7 to 60 days evaluated for fever without an obvious source. Twelve months of baseline and 12 months of implementation data were collected from emergency departments and inpatient units. Ill-appearing infants and those with comorbid conditions were excluded. Participating sites received change tools, run charts, a mobile application, live webinars, coaching, and a LISTSERV. Analyses were performed via statistical process control charts and interrupted time series regression. The 2 outcome measures were the percentage of hospitalized infants who were evaluated and hospitalized appropriately and the percentage of hospitalized infants who were discharged with an appropriate LOS. RESULTS: In total, 124 hospitals from 38 states provided data on 20 570 infants. The median site improvement in percentages of infants who were evaluated and hospitalized appropriately and in those with appropriate LOS was 5.3% (interquartile range = -2.5% to 13.7%) and 15.5% (interquartile range = 2.9 to 31.3), respectively. Special cause variation toward the target was identified for both measures. There was no change in delayed treatment or missed bacterial infections (slope difference 0.1; 95% confidence interval, -8.3 to 9.1). CONCLUSIONS: Reducing Variability in the Infant Sepsis Evaluation noted improvement in key aspects of febrile infant management. Similar projects may be used to improve care in other clinical conditions.
BACKGROUND: Substantial variability exists in the care of febrile, well-appearing infants. We aimed to assess the impact of a national quality initiative on appropriate hospitalization and length of stay (LOS) in this population. METHODS: The initiative, entitled Reducing Variability in the Infant Sepsis Evaluation (REVISE), was designed to standardize care for well-appearing infants ages 7 to 60 days evaluated for fever without an obvious source. Twelve months of baseline and 12 months of implementation data were collected from emergency departments and inpatient units. Ill-appearing infants and those with comorbid conditions were excluded. Participating sites received change tools, run charts, a mobile application, live webinars, coaching, and a LISTSERV. Analyses were performed via statistical process control charts and interrupted time series regression. The 2 outcome measures were the percentage of hospitalized infants who were evaluated and hospitalized appropriately and the percentage of hospitalized infants who were discharged with an appropriate LOS. RESULTS: In total, 124 hospitals from 38 states provided data on 20 570 infants. The median site improvement in percentages of infants who were evaluated and hospitalized appropriately and in those with appropriate LOS was 5.3% (interquartile range = -2.5% to 13.7%) and 15.5% (interquartile range = 2.9 to 31.3), respectively. Special cause variation toward the target was identified for both measures. There was no change in delayed treatment or missed bacterial infections (slope difference 0.1; 95% confidence interval, -8.3 to 9.1). CONCLUSIONS: Reducing Variability in the Infant Sepsis Evaluation noted improvement in key aspects of febrile infant management. Similar projects may be used to improve care in other clinical conditions.
Authors: Christopher P Bonafide; Rui Xiao; Amanda C Schondelmeyer; Amy R Pettit; Patrick W Brady; Christopher P Landrigan; Courtney Benjamin Wolk; Zuleyha Cidav; Halley Ruppel; Naveen Muthu; Nathaniel J Williams; Enrique Schisterman; Canita R Brent; Kimberly Albanowski; Rinad S Beidas Journal: Implement Sci Date: 2022-10-21 Impact factor: 7.960
Authors: Megan Coe; Heidi Gruhler; Matthew Schefft; Dustin Williford; Barrett Burger; Emily Crain; Alexandra J Mihalek; Maria Santos; Jillian M Cotter; Gregory Trowbridge; Jeri Kessenich; Mark Nolan; Michael J Tchou Journal: Pediatr Qual Saf Date: 2020-10-26
Authors: Katherine A Auger; Michael C Ponti-Zins; Angela M Statile; Kris Wesselkamper; Beth Haberman; Samuel P Hanke Journal: J Hosp Med Date: 2020-12 Impact factor: 2.899
Authors: Ariel Olivia Mace; Andrew C Martin; Jessica Ramsay; James Totterdell; Julie A Marsh; Tom Snelling Journal: BMJ Open Date: 2020-05-12 Impact factor: 2.692
Authors: Madeline Mier; James W Antoon; Sarah Sefcovic; Seema Awatramani; Andrew Kreppel; Sara Boblick Smith Journal: Pediatr Qual Saf Date: 2020-10-23
Authors: Lauren Z Foster; Joshua Beiner; Carol Duh-Leong; Kira Mascho; Victoria Giordani; Michael L Rinke; Leonardo Trasande; Ethan Wiener; Rebecca E Rosenberg Journal: Pediatr Qual Saf Date: 2020-01-22