P2D195: Hospital Length of Stay in Febrile Infant Evaluation

Purpose/Objectives: In August of 2021, the AAP introduced updated clinical practice guidelines for well appearing febrile infants. Historically at our institution, well appearing febrile infants were admitted for a sepsis evaluation and 48 hours of antibiotics while cultures are pending. New guidelines encourage safe discharge of these infants between 24-36 hours if all culture results are negative, changing clinical practice patterns. This project aims to evaluate our hospital’s adoption of the updated 2021 febrile infant guidelines with respect to hospital length of stay (LOS).

Design/Methods: As part of the AAP Reducing Variability in Sepsis Evaluation II national quality improvement initiative, we conducted a retrospective chart review on well appearing febrile infants between 8 and 60 days of age who presented to our hospital. We collected 12 months of baseline data followed by 15 months of active intervention data. Further qualitative chart review was performed on admitted infants. Key quality improvement interventions included the creation of a clinical pathway, creation of a standardized order set, as well as reeducation of residents, hospitalists, and emergency department providers involved in the care of these patients. SPC methodology was used to analyze monthly average hospital LOS with an X-Bar/S Chart. Chi-square testing was performed on observed practice differences between groups.

Results: 415 well appearing febrile infants between 8 and 60 days of age presented for evaluation between November 2020 and January 2023. 108 infants met inclusion criteria, requiring admission to our hospital without a known serious bacterial infection. Average monthly LOS was plotted for these infants (Figure 1). No special cause was discovered in our data. Upon further chart review, 53% of the baseline group had provider documentation of intent to continue antibiotics for 48 hours whereas only 15% of the active-intervention group had similar documentation. Chi square testing indicates a significant difference between these groups, X2 (1, N=108) =16.82, p<.001. Common themes that delayed discharge included a secondary diagnosis that required further workup, delayed HSV PCR results, contaminated blood cultures, and an unsuccessful initial lumbar puncture.

Conclusion/Discussion: Although there was no statistically significant reduction in hospital LOS, our qualitative chart review identified a significant decrease in provider intent to continue antibiotics for 48 hours, supporting clinical practice change. In addition, important barriers to discharge were identified, informing areas of future quality improvement interventions in our febrile infant evaluation.