396 - Quality Improvement through Kaiser Sepsis Infant Calculator (QIKSIC)

Poster Number: 396
Publication Number: 396.435

Justin Rowley, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Brandon R. Hadfield, UT Health San Antonio, San Antonio, TX, United States; Franz Puyol, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Meagan A. Johnson, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Murtaza N. Ali, UTHSCSA, San Antonio, TX, United States; Barbara K. Neuhoff, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Rachel Lyman, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Mandie T. Svatek, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States; Kelsey Sherburne, UT Health San Antonio Joe R. And Teresa Lozano-Long School of Medicine, Helotes, TX, United States; Joseph B. Cantey, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, United States

Background: Suspected early-onset sepsis (EOS) remains a major driver of antibiotic use in the nursery. The Kaiser Sepsis Calculator (KSC) is a validated tool that safely decreases laboratory evaluation and antibiotic administration in infants, including those who are exposed to chorioamnionitis.

Objective: Our quality improvement (QI) aim was to use a KSC-based initiative to decrease blood cultures (BCx) and complete blood counts (CBC) by 10% from March 2021 to October 2021 among infants born ≥35 weeks gestation with chorioamnionitis exposure. A secondary aim was to decrease antibiotic administration by 10%.

Design/Methods: The KSC was implemented for infants in our large academically affiliated county hospital. The project included multidisciplinary involvement from pediatric hospitalists, neonatologists, family practice physicians, maternal fetal medicine physicians, fellows, residents, and nurses. The data analyzed were from all infants born 6 months before and 7 months after protocol implementation.

Results: 53 chorioamnionitis-exposed infants were included from the pre-intervention period and 51 from the post-intervention period. CBC utilization decreased from 96% to 27%. Blood cultures decreased from 98% to 37%, and antibiotic use in these infants fell from 25% to 16%. 100% protocol application was achieved and no early onset sepsis diagnoses were missed due to the protocol change.Conclusion(s): The multidisciplinary implementation of the KSC led to a reduction in testing which exceeded our initial goal. We were able to safely reduce BCx, CBC and antibiotic use among chorioamnionitis-exposed term and late preterm infants.
Complete Blood Count and Blood Culture Control ChartsControl Charts demonstrating the average number of CBCs and Blood cultures per patient (y axis) grouped by months (x axis). QIKSIC Implementation occurred on March 1, 2021 as denoted by the arrows. The dotted lines represent the upper and lower control limits labeled UCL and LCL respectively.