Patient Selection
Eligible infants will be identified through the following 3-step algorithm:
- Obtain list of all infants 8-60 days evaluated in the ED and/or hospitalized who had:
- A temperature >38.0oC/ 100.4oF in the ED;
- An ICD-10 discharge diagnosis of fever (P81.9, R50.81 or R50.9), if not already identified by (a);
- Urine testing culture AND/OR blood culture obtained, if not already identified by (a) or (b).
- Medical record review of these infants to assess CPG inclusion criteria
- Include only those who meet the CPG inclusion criteria
Inclusion
- 8 to 60 days of age
- Temperature of ≥38.0oC/100.4oF documented at home/clinic in past 24 hours or in ED
- Full term (between ≥37 and <42 weeks gestational age)
- Well-appearing
Exclusion
- Prematurity
- Chronic medical condition
- <2 weeks of age with a complicated perinatal course
- Ill-appearance
- Diagnosis of bronchiolitis
- Specific bacterial infection on physical examination (e.g., cellulitis, omphalitis, septic arthritis, or osteomyelitis)
- High suspicion of herpes simplex virus infection (e.g., vesicles)
- Antibiotic treatment within the prior 48 hours
- Immunization within the prior 48 hours
Measurement Grid
|
Type |
Name |
Definition |
|
Primary Measure |
Appropriate CSF |
90% of infants 29-60 days with normal inflammatory markers (and either a negative UA OR a positive UA) DO NOT have CSF obtained |
|
Primary Measure |
Appropriate Disposition from ED |
90% of infants 29-60 days with normal inflammatory markers and negative UA discharged from the ED |
|
Primary Measure |
Appropriate receipt of antibiotics |
90% of infants 29-60 days with normal inflammatory markers and negative UA DO NOT receive antibiotics |
|
Primary Measure |
Appropriate Hospital Discharge |
90% of infants 8-60 days with negative cultures have appropriate discharge from the hospital within 36 hours from the time blood cultures were received by the laboratory |
|
Secondary Measure |
Appropriate follow-up |
75% of infants 22-60 days discharged from the emergency department have documented education with parents about the importance of follow-up within 1 calendar day |
|
Secondary Measure |
Appropriate Parent Engagement: CSF |
75% of infants 22-28 days with normal inflammatory markers and negative UA have documented physician-parent discussion about the harms/benefits of having CSF obtained |
|
Secondary Measure |
Appropriate Parent Engagement: Disposition |
75% of infants 22-28 days with normal inflammatory markers, negative UA, and normal CSF have documented physician-parent discussion about the harms/benefits of hospitalization vs. discharge from the ED after one dose of parenteral antibiotic therapy |
|
Secondary Measure |
Oral Antibiotic Use for Infants 29-60 Days with Positive UAs |
Oral Antibiotic Use for Infants 29-60 Days with Positive UAs 75% of infants 29-60 days old with a positive UA, negative inflammatory markers, and normal CSF (if obtained) receive oral antibiotics (with or without ONE dose of parenteral antibiotic therapy) |
|
Balancing Measure |
Appropriate Evaluation: 8-21 days |
% of infants 8-21 days who have a urinalysis and/or urine culture, blood culture, and CSF culture obtained, and who are hospitalized on parenteral antibiotic therapy |
|
Balancing Measure |
Appropriate Evaluation: 22-60 days |
% of infants 22-60 days who have a urinalysis and/or urine culture, blood culture, and inflammatory markers obtained |
|
Balancing Measure |
Readmission |
% of infants 22-60 days who did not have CSF obtained or receive antibiotic therapy who are readmitted to the hospital within 7 days of discharge |
|
Balancing Measure |
Delayed diagnosis of IBI |
% of infants age 22-60 days discharged from the emergency department or hospital who did not have CSF obtained or receive antibiotic therapy who have a diagnosis of bacteremia and/or bacterial meningitis within 7 days of discharge |