35 - Improving Antibiotic Times in Patients with Open Fractures in a Pediatric Emergency Department

Poster Number: 35
Publication Number: 35.406

Tyler S. Arnold, Indiana University School of Medicine, Carmel, IN, United States; Lauren E. Buenger, Riley Hospital for Children at IU Health, Indianapolis, IN, United States; Cory Showalter, Indiana University School of Medicine Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States

Background: Orthopedic injuries and fractures are quite common in pediatric emergency departments (ED). Rare open fractures require prompt identification and treatment with parenteral antibiotic administration to prevent complications such as wound infections. The American College of Surgeons recommends antibiotics within 1 hour of arrival to the emergency department, and locally, we were not consistently meeting this goal. We aimed to improve our ability to identify and rapidly treat pediatric patients with open fractures through the creation and implementation of a standard approach to orthopedic initial assessment in our ED. 

Objective: Our objective was to increase the percentage of patients with open fractures receiving antibiotics within 1 hour of arrival above 80% by December 2021. 

Design/Methods: A single plan-do-study-act (PDSA) cycle was instituted in June 2020 that included weekly emails to physicians and nurses caring for patients with open fractures, creation of a process to identify individuals in triage with deformed extremities, and nurse/physician education. To measure improvement, we identified all patients from January 1, 2018 – January 1, 2021, based on ICD-10 code for open fractures in the trauma registry at Riley Hospital for Children. Patients were included if they had an open tibia, fibula, femur, ulna, radius, or humerus fracture; they were excluded if they received antibiotics prior to arrival, were 18 years or older, or died in the ED.  

Results: Since the implementation of our PDSA cycle, we have achieved an 89% compliance rate in administering antibiotics within 1 hour of arrival in patients with open long-bone fractures, improved from 39% pre-intervention. As a result, our average time to antibiotics has decreased from 80 minutes to 33 minutes post-intervention (p  < 0.01). Conclusion(s): After instituting a protocol for prompt recognition and treatment of all potential fractures in the emergency department, we were able to improve the percentage of patients receiving antibiotics within 1 hour with open fractures, and as a result, the average time to antibiotics decreased in these patients.