Effect of an Institution-Specific Guideline on Adherence to the 2021 American Academy of Pediatrics Guidelines for Febrile Infants at a Community Emergency Department: A Quality Improvement Initiative

IF 3 Q2 HEALTH CARE SCIENCES & SERVICES

Joint Commission journal on quality and patient safety Pub Date : 2026-08-01 Epub Date: 2026-04-26 DOI:10.1016/j.jcjq.2026.04.007

Alisha Ching MD (is Clinical Assistant Professor, Department of Emergency Medicine and Department of Pediatrics, University of Michigan Medical School.), Allison Cator MD, PhD (is Clinical Assistant Professor, Department of Emergency Medicine and Department of Pediatrics, University of Michigan Medical School.), Michele Carney MD (is Clinical Professor, Department of Emergency Medicine and Department of Pediatrics, University of Michigan Medical School.), Ruoer Bei MS (is PhD student, George Washington University.), Yaseen Rafee MD (is Associate Professor, Department of Pediatrics, College of Human Medicine, Michigan State University.), Nesma Ghanim MD (is Pediatric Infectious Diseases Fellow, Texas Children’s Hospital.), Tim Tomy MD (is Pediatric Resident, Hurley Medical Center, Flint, Michigan.), Adenike Fatiregun MBBS (is Neonatology Fellow, Medical College of Georgia.), Mai Elhadi MBBS (is Child Neurology Resident, Department of Pediatrics, Duke University School of Medicine.), Courtney W. Mangus MD, MSc (is Assistant Professor, Department of Emergency Medicine and Department of Pediatrics, University of Michigan Medical School. Please address correspondence to Alisha Ching)

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Abstract

Background

In a community hospital emergency department (ED), wide practice pattern variation in the management of febrile infants ≤60 days was noted following the release of the 2021 American Academy of Pediatrics (AAP) guidelines. The authors identified a need to standardize practice and improve adherence to AAP recommendations in the care of febrile infants. The aim of this study was to improve ED provider adherence to AAP febrile infant guidelines to > 80% within 18 months.

Methods

In this quality improvement initiative, institution-specific febrile infant guidelines and corresponding order sets in the electronic health record based on the AAP recommendations were developed. Age-based, institution-specific algorithms for diagnosis and management of febrile infants were distributed to ED providers. The researchers engaged in multiple Plan-Do-Study-Act cycles of targeted interventions and tracked provider adherence to AAP recommendations over 18 months. ED length of stay (LOS) for all patients and rate of blood cultures for febrile infants > 60 days were tracked as balancing measures.

Results

Despite an initial improvement in provider adherence to AAP recommendations from a baseline of 59.1% to 82.0% immediately following implementation of the institution-specific guidelines, there was a subsequent return to 64.3% over 18 months postimplementation. Adherence fluctuated with substantial variability over time. The small overall improvement in adherence postimplementation of the guideline was not statistically significant. There was no statistically significant change in ED LOS for all patients or rate of blood cultures in older infants as a result of the interventions.

Conclusion

This project’s interventions resulted in statistically nonsignificant improvements in adherence to AAP guidelines for febrile infants ≤ 60 days old. Ongoing, high-reliability interventions may be required to consistently improve adherence to AAP guidelines.

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机构特定指南对遵守2021年美国儿科学会社区急诊科发热婴儿指南的影响：一项质量改进倡议。

背景：在社区医院急诊科（ED），在2021年美国儿科学会（AAP）指南发布后，注意到≤60天发热婴儿管理的广泛实践模式变化。作者确定需要标准化的做法，并提高对AAP建议的依从性，以照顾发热婴儿。本研究的目的是在18个月内将急诊科医生对AAP发热婴儿指南的依从性提高到80%。方法：在这一质量改进倡议中，根据美国儿科学会的建议，制定了针对机构的发热婴儿指南和相应的电子健康记录顺序集。基于年龄的、机构特定的算法用于诊断和管理发热婴儿分发给急诊科提供者。研究人员参与了多个计划-执行-研究-行动周期的目标干预，并在18个月内跟踪提供者对AAP建议的遵守情况。所有患者的急诊科住院时间（LOS）和60天内发热婴儿的血培养率被跟踪作为平衡措施。结果：尽管在实施机构特定指南后，提供者对AAP建议的依从性从59.1%的基线提高到82.0%，但在实施后的18个月里，这一比例又回到了64.3%。依从性随时间的变化而波动。指南实施后依从性的小的整体改善没有统计学意义。干预的结果是，所有患者的ED LOS或大婴儿的血培养率没有统计学上的显著变化。结论：本项目的干预措施导致小于60天的发热婴儿对AAP指南的依从性无统计学意义的改善。可能需要持续的、高可靠性的干预措施来持续提高AAP指南的依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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