University of Pittsburgh- Children's Hospital of Philadelphia

Reduction of Empiric Antibiotics Among Late Preterm/Term Infants Undergoing Early Onset Sepsis Evaluations

Project Lead: Anne-Marie Rick, MD, MPH, PhD

Project AIM(s): By May 2021, we will decrease empiric antibiotic exposure by 30% among newborns 35 weeks’ gestational age or later undergoing evaluation for early-onset sepsis (EOS), using recommended, evidence-based EOS screening guidelines.

Narrative Description

We focused our project specifically on decreasing empiric antibiotic exposure by the goal of 30% among newborns 35 weeks gestational age or later undergoing evaluation for early-onset sepsis (EOS), using recommended, evidence-based EOS screening guidelines at Philadelphia Children’s Hospital and surrounding Pediatric Clinics. Of the four sites that completed the collaborative, two had >5,000 annual deliveries, and two had < 1,000 yearly deliveries. One was a community-based center, and three others were academic centers. Two sites implemented the multivariate risk calculator, one serial exam, and one an empiric approach using a definite threshold. Over the action period, sites shared and implemented tools obtained through the network, including code for electronic health record screening, forms for documentation, and parent engagement tools.

We faced several challenges when starting our project around IT and data analytics. We did have one site that had difficulty with data entry, but we resolved this by assisting them with data abstraction to allow final data analysis. During the evaluation and data gathering period, there was a 20% reduction in blood cultures, 20% reduction in sepsis laboratory testing, and 45% reduction in antibiotic use (Figures 1-3). There was no difference in several positive blood cultures identified during the baseline and intervention periods (5% vs. 3.9%). And although 90% of those who had a positive blood culture in the intervention period were initially observed without antibiotics, only two developed any symptoms, and none experienced adverse events or severe outcomes due to their observation off antibiotics.

The results of our work demonstrate that implementing any of the new EOS screening recommendations results in safe and measurable decreases in antibiotic and laboratory evaluations for infants regardless of nursery setting and can be completed through adaptation of these guidelines to each unique environment. This is critical as increased nurseries consider making these changes. The support provided through regular collaboration and discussion with multiple sites engaging in similar changes was encouraging to smaller sites who saw these infants less often.

Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention

  • Failure in information gathering
  • Failure in information integration

Root causes/causative factors addressed by the intervention

  • Workflow (includes testing, follow-up, and referrals)
  • Health information sharing and accessibility via health IT
  • Diagnostic patient safety culture

Setting of the diagnostic quality improvement intervention

  • Acute care hospital inpatient area
    • Inpatient non-intensive care area (e.g., adult or pediatric medical/surgical, maternity, psychiatric unit)
    • Special care area (e.g., ICU, CCU, NICU, step-down unit)