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Introduction <p>Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED).</p> Methods <p>A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control.</p> Results <p>Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; <i>p</i> = 0.65) nor missed serious bacterial infections (0% vs 0%).</p> Conclusions <p>Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.</p>

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Reducing antibiotic overuse in immunocompetent children with febrile neutropenia in a pediatric emergency department: a quality improvement initiative

  • 期刊论文

  • 发表日期：

    2026年2月3日

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  • Katherine Girgulis,
  • Jennifer Thull-Freedman,
  • Nicola Wright

摘要

Introduction

Management of febrile neutropenia in previously healthy, presumed immunocompetent children varies. Unnecessary treatment impacts the patients, families, and the healthcare system. With guidance from a Canadian Paediatric Society Practice Point, most well-appearing children with a first episode of febrile neutropenia can be managed with reduced exposure to antibiotics and close outpatient follow-up. The aim of this initiative was to safely reduce antibiotic use in this low-risk population presenting to the emergency department (ED).

Methods

A multidisciplinary team designed a quality improvement (QI) initiative. From July 2022 to July 2024, treatment with antibiotics was classified as indicated or non-indicated according to guidance from the Practice Point. Interventions involved guideline dissemination, provider education, and point-of-care tools to facilitate clinical decision-making and follow-up. Outcome measures included the proportion of children receiving antibiotics, hospital admission, and appropriate laboratory follow-up. Re-presentation to ED and missed serious bacterial infections were monitored as balancing measures. Analysis of the primary outcome was by statistical process control.

Results

Three hundred and ninety-eight (398) children with febrile neutropenia were included. The proportion of non-indicated antibiotics was 6.7% at baseline. Statistical process control analysis of the G-chart demonstrated special cause variation with 97 consecutive cases occurring without error (non-indicated antibiotics). Following the occurrence of special cause variation until the end of the study, only 1.6% of children received non-indicated antibiotics. There was no increase in re-presentations to ED (9% vs 8%; p = 0.65) nor missed serious bacterial infections (0% vs 0%).

Conclusions

Quality improvement methodology can facilitate the timely adoption of best practices to align local clinical care with new national guidelines. Implementation of the national guideline allowed low-risk children with febrile neutropenia to avoid overtreatment.