Wednesday, May 9, 2012

Protocol In Place For Pediatric Cancer Patients Arrival to E.R.

Parents of children with cancer will be pleased that pre-arrival protocol has been placed in some Emergency Departments to shorten the time for the pediatric patient. Children with cancer can easily have fevers that need to be addressed due to a compromised immune system because of chemotherapy. Parents are already very stressed due to what it is required dealing with all the scheduled treatments at cancer centers. They do not need to have deal with a long wait when they sense that their child is seriously ill.

Recent news of a plans in place for every pediatric patient diagnosed with cancer.
By implementing a standardized referral notification to the ED physician and charge nurse, using a standardized electronic health-record-based referral checklist with patient-specific information, and using a standardized order set for laboratory tests and antibiotics at the time of referral, investigators reduced the median time to antibiotic administration by almost an hour, according to Evaline Alessandrini, MD, MSCE, from the division of emergency medicine at the Cincinnati Children's Hospital Medical Center and professor of pediatrics at the University of Cincinnati College of Medicine in Ohio.
Dr. Evaline Alessandrini
Dr. Alessandrini explained that the timely delivery of antibiotics to febrile children with cancer presented an opportunity to test elements of the Chronic Care Model related to health systems and to the organization of healthcare. Previsit planning is a critical part of chronic disease management. Specifically, delivery system design, decision support, clinical information systems, and a prepared practice team lend themselves to the development of a prearrival plan.
Our data demonstrated that the largest gaps in care are between ED arrival and the time that orders for antibiotics are written, Dr. Alessandrini explained. "We planned to close the gap by ordering the antibiotics before the patient arrived in the ED."
For trauma alerts, roles are assigned and equipment and medications prepared before the patient arrives. "Our goal was to transfer these activities to the ED during the management of acute exacerbations of chronic disease," she said.

The researchers wanted to reduce the time from patient arrival to the administration of antibiotics for pediatric cancer and bone marrow transplantation patients with fever from 140 minutes to less than 90 minutes. The setting was an urban tertiary-care children's hospital ED. The hospital has a high-volume oncology and bone marrow transplantation service that sees febrile patients in its clinic during weekday daytime hours. At other times, the children are seen in the ED. Because all of the children are immunosuppressed, there is no reason to wait for a complete blood count before giving antibiotics.

This plan has reduced time in the Emergency Department for about 100 minutes.

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