P2D191: Appropriate Emergency Room Discharge of Febrile Infants

Purpose/Objectives:

Introduction:
The AAP introduced updated clinical practice guidelines for well appearing febrile infants in August of 2021. Historically at our institution, well appearing febrile infants, 29-60 days old, discharged from Emergency Department (ED) had no standard discharge follow up recommendations. New guidelines encourage safe discharge of these infants, with recommendation for 1 day follow-up, with their primary care provider (PCP). The goal of this project is to evaluate our ED’s adoption of the updated 2021 febrile infant guidelines with respect to 1 day follow up with their PCP.

Design/Methods: 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 gathered demographic information as well as project specific metrics including appropriate discharge follow up recommendations, discharge with antibiotics, and 7-day return rate. 12 months of baseline data was collected followed by 16 months of post-intervention data. Key quality improvement interventions included an ED specific discharge order set, creation of an inpatient clinical pathway, as well as reeducation of providers involved in the care of these patients including residents, hospitalists, and emergency department providers. A P-chart was used to analyze appropriate discharge recommendations and chi squared testing was performed on notable practice difference between pre and post-intervention groups.

Results:

Results:  
Throughout this study, 268 patients were discharged from the ED. Of these patients 75% were White, 13% Hispanic or Latino and 6% were African American, with 1% being Other. 54% were male. Average age was 45 days. The biggest change noted in the Emergency Room was the number of patients discharged with recommendations for 1-day follow-up. Pre-intervention 62.5% of patients were discharged with a recommendation for 1-day follow-up with PCP. After the intervention, 81% of patients were discharged with a 1-day follow-up with PCP, which was statically significant (p < 0.05). Improvement is demonstrated on p-chart (See Figure 1). The rate of 7-day return did not change significantly (both 10.7, p=0.99). Patients discharged from the ED on oral antibiotics pre-intervention were 3.6% compared to 4.4% post intervention (p=0.79).

Conclusion/Discussion: Discussion/conclusion: 
There was an 18.5% increase in the number of patients discharged from the ER with appropriate follow up recommendations. This practice change shows the adaptability of the ED staff and providers as well as the effectiveness of implementing a clinical pathway and reeducation of all providers involved.