Background:The presence of fever in an under six week old baby (USWOB) is a common presentation to the emergency department (ED). Although fever within this population is often idiopathic, it may also be a clinical marker indicating a serious bacterial infection (SBI). As many within this population often appear initially clinically well, a septic screen is usually required to determine the risk of a SBI being present.
Aims: To investigate the current management of the febrile under six week old baby in New Zealand emergency departments.
Methods: A two part study was conducted. Part one involved a NZ wide anonymous survey of ED’s aiming to gain an insight into how fever is defined, what guidelines are used and what nurses’ involvement is in the septic screen process. Part two included a retrospective audit of a single major tertiary ED within NZ of all febrile under six week old babies presenting within one year. This examined the processes involved during the babies’ management within the ED including the clinician completing the investigations, time to septic screen completion and hypothesised variables effecting this time.
Results: The reported definition of fever from participating ED’s ranged from 37.5°C to 38.1°C. Of the 8 completed survey responses, 50% of the ED’s reported having a guideline for the management of the febrile USWOB. Nurses were able to complete catheterisation in 63% of the departments, however were able to initiate and complete other components of the septic screen less than a quarter of the time. Of the 979 USWOB presentations to the single site ED over one year, 58 were identified as febrile on initial nursing assessment, and 30 received a complete septic screen. The most common missing component was the lumbar puncture. The mean time to full septic screen completion was 204 minutes. Triage score, room placement and age of patient had no effect on their time to septic screen completion.
Conclusions: The current management of the studied population varies between ED’s, with minimal nurse involvement in septic screen processes. Nearly half of all febrile USWOB do not receive a complete septic screen. The time to a full septic screen completion is over three hours. Further analysis of data and future studies need to examine whether this has any influence on patient outcome, identify missing influencing factors and improve time to screening completion.
Counties Manukau Health