Reducing Variability in the Infant Sepsis Evaluation

The management of fever in infants 60 days old has been a topic of much ambiguity for decades. Due to an immature immune system and unique pathogens, the febrile infant is at high risk for bacterial infections, in particular urinary tract infection, bacteremia, and bacterial meningitis. The prevalence of bacterial infection in febrile infants 60 days of age is 8% to 12.5%.1 The prevalence of potentially life-threatening bacteremia and/or bacterial meningitis, i.e., invasive bacterial infection (IBI), is 2%.2 Starting two decades ago, several criteria were created to identify febrile infants at low-risk of bacterial infection, and the criteria are utilized to potentially avoid hospitalization in certain low-risk patients.3-5 More recently, newer risk stratification algorithms that incorporate biomarkers such as procalcitonin and C-reactive protein have been developed and validated in febrile infants.6 However, due to varying risk stratification algorithms and institutional norms, there is wide practice variation in the management of febrile infants.7 With the publication of the American Academy of Pediatrics (AAP) clinical practice guideline for the evaluation and management of well-appearing febrile infants 8-60 days old, there is great potential to provide evidence-based, standardized care to febrile infants 60 days ols evaluated in the hospital setting. 
 
This project sought to implement the evidence-based AAP febrile infant clinical practice guideline in a national QI collaborative designed to improve and standardize care for febrile infants between the ages of 8 to 60 days. Using the recommendations in the febrile infant clinical practice guideline, the QI effort provided hospitalist and emergency medicine physicians with education about evidence-based best practice, strategies for implementation, and tools to bring about sustainable change, while also assessing the implementation strategies associated the greatest success. Providing multi-disciplinary teams with quality improvement education and tools specific to management of children with fever will increase compliance with the evidence-based research and thereby decrease overuse of non-evidence-based therapies and tests.  

Project Structure

This QI project sought to standardize evidence-based evaluation and management of febrile infants 8 to 60 days of age by implementing the AAP clinical practice guideline for febrile infants. The project provided participating sites with webinars, pathways, QI education, a literature bundle, and a toolkit for parent education and engagement. Optional resources include intensive data review with a QI coach, individual provider feedback, and building QI expertise webinars.