44 - Standards of Care and Quality Indicators for young febrile infants in Emergency Departments

Poster Number: 44
Publication Number: 44.406

Roberto Velasco, Hosp. Univ. Río Hortega, Laguna de Duero, Castilla y Leon, Spain; Borja Gomez, Pediatric Emergency Department. Cruces University Hospital, Barakaldo, Pais Vasco, Spain; David Andina, HOSPITAL INFANTIL UNIVERSITARIO NIÑO JESUS, LAS ROZAS, Madrid, Spain; Ainara Lejarzegi, Osakidetza, Zalla, Pais Vasco, Spain; Estibaliz Izarzugaza, Cruces University Hospital, Spain, Pais Vasco, Spain; Santiago Mintegi, Hospital Universitario Cruces, Bilbao, Pais Vasco, Spain; Study Group for Febrile Infant of RISeuP-SPERG network, Sociedad Española de Urgencias de Pediatría, Madrid, Madrid, Spain

Background: Quality indicators are tools to monitor and control efficiency of the system key segments, while the results collected serve as a basis for implementation of corrective measures and continuous quality improvement. Despite the existing clinical practice guidelines, there is wide variation in management of the febrile young infant in the emergency departments (ED). Designing standards of care and quality indicators may be the first step to improve care variation.

Objective: To design essential quality indicators for the management of febrile infants ≤90 days old.

Design/Methods: A multicenter study was developed including pediatric emergency physicians from 24 Spanish EDs, endorsed by the RISeuP-SPERG Network.

Initially, after an extensive review of the literature (in particular, the clinical practice guidelines of the American Academy of Pediatrics, 2021), a group of five febrile infant experts elaborated a list of standards of care in the management of the febrile young infant. The list was prepared by brainstorming technique in two meetings via teleconference.

In a second phase, using a Delphi method, a questionnaire based on the list of standards of care
was sent to site investigators, who evaluated the clinical relevance of each item using a 7-points Likert scale. Those items with a score ≥4 by at least 70% of the site investigators were included in the final list and those that obtained less than 50% were eliminated.

Finally, the five experts designed a quality indicator for each of the standards of care included in the final list in collaboration with quality experts of one of the participating hospitals. The indicators were designed to cover the six domains of Health Care Quality (Safe, Effective, Patient-centered, Timely, Efficient, Equitable). Those indicators that obtained a score≥4 by at least 95% of the site investigators and all the experts were considered as essential.

Results: We established 20 indicators related to organization (1), triage (2), diagnostic process (9), treatment (6), and disposition (2), covering the six domains of Health Care Quality. The following ones were considered as essential indicators: having an ED management protocol, performing a urine analysis in every infant, obtaining a blood culture in every infant and administering antibiotics in the ED to any not-well-appearing infant.Conclusion(s): Through a standardized method, we have elaborated a comprehensive list of quality indicators for the ED management of febrile young infants. This may be the basis for implementation of corrective measures and continuous quality improvement.