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Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement

QI 7: Primary & Subspecialty Outpatient QI Group 2

267 - Enhancing Early Identification of Hypothermic Infants in Pediatric Primary Care

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 267
Publication Number: 267.453

Anne Mescher, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Allison Reyner, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States; Haley Schlottmann, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Mary Burkhardt, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Presenting Author(s)

Mary Burkhardt, MD, MHA (she/her/hers)

Associate Division Director, Primary Care
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Background: Hypothermia can often be the first, and only, sign of sepsis in young infants. There is a paucity of standard recommendations for office-based pediatric primary care management of infants at risk of, or showing signs of, hypothermia.

Objective: This quality improvement project’s primary aim was to standardize the early and accurate identification of infants at risk of hypothermia in a pediatric primary care office by decreasing the variation of documented office temperatures ≤36.5◦C from 24% to 10% over 3 years. The secondary aim was to determine the frequency of hypothermia, understand which patients could be managed in primary care, and appropriately triage the highest risk infants to the appropriate level of care.

Design/Methods: A multidisciplinary outpatient primary care quality improvement team convened to understand, develop, and implement a standardized multidisciplinary office procedure to identify and manage infants at risk for hypothermia. Current literature was reviewed, and office workflow mapped to inform key drivers. Key drivers included: 1. Increased awareness about infant hypothermia 2. Nursing staff education 3. Evidence based criteria for identifying at risk infants 4. Staff empowerment and 5. Staff and office buy-in (Figure 1). Ultimately an office-based algorithm was created, tested, adapted, and ultimately adopted to screen, accurately identify, and manage infants at risk for hypothermia (Figure 2). Electronic health data were used to create a run chart, and descriptive statistics were obtained. Chart reviews were also conducted to determine disposition and final diagnoses of identified patients.

Results: Variation in documented office temperatures ≤36.5◦C decreased from 24% to 7% over the three years of active work (Figure 3). There were 8,020 encounters with infants 0-49 days and 13.4% (n=1,078) had a documented temperature of ≤36.5◦C, accounting for 951 unique infants. Of the 951 infants with an at-risk temperature of ≤36.5◦C, 96.1% (n=914) were able to be rewarmed in the office, avoiding escalation of care. Thirty-one patients ultimately required hospitalization. Most common diagnoses necessitating admission were temperature instability, “rule out sepsis”, poor feeding, hyperbilirubinemia, and sepsis.

Conclusion(s): Application of QI methods in a primary care office decreased documented temperature variations in infants through standardizing care, empowering staff, and ultimately improved the triage of at-risk infants to the most appropriate level of care.