Clinical Pathway Reduces Invasive Care for Low-Risk Febrile Infants

By Megan Brooks

February 07, 2019

NEW YORK (Reuters Health) - Connecticut Children's Medical Center in Hartford has successfully reduced invasive interventions for febrile infants at low risk for serious bacterial infection (SBI) without missing any SBIs by implementing a clinical pathway supported by a continuous quality improvement efforts.

"Our study reveals that using QI processes to support clinical pathway implementation can be a key strategy in the delivery of evidenced-based care for febrile infants," write Dr. Kathryn E. Kasmire and colleagues online February 6 in Pediatrics.

There is significant variation in how febrile infants are managed. Dr. Kasmire and colleagues formed a multidisciplinary team to develop and implement an evidence-based clinical pathway with continuous QI to sustain its use including order-set development and e-mail reminders.

The aim was to reduce lumbar puncture (LP), antibiotic use and hospital admission for infants at low risk for SBI (based on modified Rochester criteria) to less than 10% in 12 months without missing SBI.

The Pediatrics paper describes a pre- and post-pathway implementation analysis of the evaluation and management of 350 febrile infants aged 29 to 60 days (220 pre-implementation and 130 post-implementation).

In the year following implementation, the study goals were achieved. LPs decreased from 32% to 0%, antibiotic administration from 30% to 1%, and hospital admission from 17% to 2% in low-risk febrile infants.

"This was achieved without detriment to the identification of SBIs or care of high-risk infants," the researchers report. After implementation, there were no missed SBIs in low-risk infants.

In email to Reuters Health, Dr. Kasmire who is affiliated with Connecticut Children's and Hershey Medical Center in Pennsylvania, said, "Many other children's hospitals are already using similar pathways. My advice to successfully implement a new pathway such as our pathway for evaluation of infants with fever is to provide education for and get buy-in from all key stakeholders."

The study had no commercial funding and the authors have declared no conflicts of interest.


Pediatrics 2019.