An Initiative to Decrease Time to Antibiotics for Patients With Fever and Neutropenia

The objective was to decrease the time to antibiotic administration for patients arriving in the pediatric emergency department with fever and neutropenia. A multidisciplinary team was assembled and engaged in process analysis through interviews and data review. These findings were used to develop key drivers, and Pareto charts were utilized to prioritize interventions. Interventions were tested and implemented using rapid Plan-Do-Study-Act cycles. Progress was monitored using process control charts. Interventions included leveraging a secure text-based messaging platform, creating a new antibiotic pathway, and educating staff and family. Between September 2016 and September 2017, the average time to antibiotics was decreased from 116 to 55 minutes in this population. This also was associated with a decrease in variation (individual moving range mean decreased from 43 minutes to 18 minutes). Careful process analysis, coupled with the work of a multidisciplinary team, produced significant improvements in efficiency of care for these vulnerable patients.