P2.D071: Impact of Multidisciplinary Education and Data Sharing on Reducing Time to Antibiotic Administration to Pediatric Patients with Open Fractures

Purpose/Objectives: Early antibiotic administration has been identified as the most important factor to prevent infection in patients with open fractures. Current American College of Surgeons (ACS) best practice guidelines recommend administration of antibiotics within 60 minutes of arrival to the emergency department (ED), and this metric is followed to verify a hospital as a trauma center. Recent studies suggest that adherence to these guidelines is either poor or inconsistent. In 2023, at our level 1 pediatric trauma care ED, our mean time to antibiotic (TTA) for patients with open fractures was 108 minutes, and 45% of patients with open fractures received antibiotics beyond the 60-minute goal. Our quality improvement (QI) project aimed to reduce the TTA to less than 60 minutes for patients with open fractures during the subsequent 12 months.

Design/Methods: Our QI strategy focused on two intervention categories which we started simultaneously in June 2023: education and data-sharing. The settings for these interventions included monthly physician and nurse staff meetings, daily pre-shift nurse safety huddles, and new nurse orientation. The content included the goal of antibiotic administration within 60 minutes of patient arrival, the specific antibiotic(s) advised based on injury severity, and baseline data that identified the patients with the greatest opportunity for improvement were level 2 and 3 (non-critical) trauma activations. As the project progressed, we included on-going performance data on TTA for each patient (Figure).

Results: After implementation of our education and data sharing, we noted a near-immediate reduction in TTA. Our data show that a new TTA centerline was established within three months (Figure). This reduction in TTA was sustained for nearly 40 weeks, with a mean TTA of 50 minutes. There was little variation in performance apart from a single patient whose open fracture was identified after delayed splint removal in the context of unique circumstances. Barriers to identifying this patient’s open fracture were addressed via a patient care team debriefing and department-wide re-education with the specific case description. Thereafter, TTA remained within a range of 15 to 61 minutes.

Conclusion/Discussion: Our QI efforts to reduce TTA for pediatric patients with open fractures produced near-immediate and sustained improvement with only focused education and data-sharing. Such improvements to timely care more typically require higher reliability interventions such as electronic medical record alerts or hard-stop decision support. Our results suggest that improvements in straightforward or single system clinical presentations may be effectively addressed by simple QI interventions as a first step. Data-sharing was critical to our success, and we recommend periodic education with data-sharing to ensure sustained high-quality care.