Care process model to treat feverish infants with possible serious bacterial infections improves outcomes, lowers costs
Implementing an evidence-based care process model (EB-CPM) for treating feverish infants up to age 3 months at pediatric or community hospitals can result in better diagnosis, shorter hospitalizations, shorter antibiotic treatment, and lower health care costs, according to a new study. Infants in this age range are often brought to the doctor because they have a fever that might represent a life-threatening serious bacterial infection (SBI). Although most of these fevers are indicators of viral or urinary tract infections, approximately 10 percent indicate the patient has an SBI. Physical examination alone cannot distinguish feverish infants with SBI from infants with less dangerous infections, the researchers note. In response, they developed an EB-CPM that includes a history, physical examination, complete blood count (CBC), and urinalysis for all febrile infants. During the study period, the researchers observed 735 culture-confirmed cases of SBI, representing 9 percent of all febrile episodes and 12 percent of 6,363 infants who underwent bacterial cultures of their blood, urine, or cerebrospinal fluid.
After implementation of the EB-CPM in 2008, the researchers saw a 13 percent increase in infants who received recommended laboratory tests, with almost all admitted infants having a CBC and a urinalysis (93 percent and 99 percent, respectively). They also saw higher percentages of infants having blood or urine cultures. In 61 percent of the febrile episodes, infants received antibiotic therapy. Infants at high risk of SBI were more likely to receive antibiotics than low-risk infants (85 percent vs. 63 percent). After implementation of the care process model, the mean hospital length of stay for infants without SBI shrunk from 60 hours to 44 hours, reducing total hospital stay by 1,644 days. In spite of shorter stays, there were no missed cases of SBI and several infant outcomes were improved, such as establishing viral or bacterial diagnoses and receipt of appropriate antibiotic therapy. The researchers estimated that the reduced costs per feverish infant admitted after model implementation represented savings of around $1.9 million.
The study included 8,044 infants with 8,431 episodes of fever that resulted in evaluation at a tertiary children’s hospital and four regional medical centers in Utah from 2004 through 2009. Data from 2004–2007 represented baseline and training periods, and 2008–2009 represented implementation. The study was funded in part by the Agency for Healthcare Research and Quality (HS18034).
More details are in "Costs and infant outcomes after implementation of a care process model for febrile infants," by Carrie L. Byington, M.D., Carolyn C. Reynolds, M.S., Kent Korgenski, M.S., and others in the July 2012 Pediatrics 130(1), pp. e16-e24.