561 - Sustaining Improvement in Time to Antibiotics in Febrile Pediatric Oncology Patients Presenting to the Pediatric Emergency Department (PED)

Publication Number: 2546.561

Isabella Yu, Cohen Children's Medical Center, New Hyde Park, NY, United States; Kimberly Kahne, Cohen Children's Medical Center, New Hyde park, NY, United States; Tabetha Garver-mosher, Northwell Health, New York, NY, United States; Kristy Williamson, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Garden City, NY, United States; Laura LaMaina, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Ryan Hardardt, Cohen Children's Medical Center, New Hyde Park, NY, United States; Kimberly A. Giusto, Northwell Health, rockville centre, NY, United States

Background: The accepted goal time to antibiotic (TTA) administration in pediatric oncology patients presenting with fever is 60 minutes. "Code Onc," a process to streamline antibiotic administration at our hospital, initially showed significant improvement in TTA in this patient population, but it was not sustained over the years. In 2023, a Failure Mode and Effects Analysis (FMEA) identified areas for improvement in this process. During this time our mean TTA decreased from 78 to 55 minutes and the percentage of patients receiving antibiotics in less than 60 minutes improved from 26% to 69%. While initial improvements are common for quality improvement initiatives, sustainability is more challenging. Various key factors influence the sustainability of projects, therefore leading to variable outcomes.

Objective: This study aims to maintain the percentage of patients receiving antibiotics under 60 minutes in febrile oncology patients presenting to the PED at 60% or greater from February 2024 through August 2025.

Design/Methods: Our FMEA QI project was completed in January 2024, and the sustainability phase began in February 2024. This phase involved ongoing education at group meetings, individual education with new staff, and the presentation of metrics at group meetings to promote overall awareness of our data and identify areas of delay. Code Onc data was presented to PED leadership on a weekly, followed by a biweekly basis. Individual case reviews were performed by leadership when appropriate. Cases with delays in TTA were discussed with physicians and nurses involved in the patient's care to continue to find areas with need for improvement and individual awareness of one's own delays in care.

Results: From February 2024 through August 2025, the improvement in mean TTA was sustained. The average TTA was sustained at an average of 52 minutes, and 75% of cases were under 60 minutes, thus meeting our goal of greater than 60%. We maintained our centerline on our control chart without any undesired shifts.

Conclusion(s): With continuous education, frequent reminders, and data collection, we were able to effectively sustain a high percentage of patients receiving antibiotics under 60 minutes for 19 months. By improving TTA, we are hopefully improving morbidity and mortality in a high-risk patient population.

Mean Time to Antibiotic Administration Control Chart