Decreasing Variation to Enhance Accurate Identification of Hypothermic Infants in Pediatric Primary Care

• Published in: Clinical pediatrics 2024-07, Vol.63 (7), p.963-970
• Main Authors: Burkhardt, Mary Carol, Schlottmann, Haley, Reyner, Allison, Mescher, Anne
• Format: Article
• Language: English
• Subjects: Female; Humans; Hypothermia; Hypothermia - diagnosis; Hypothermia - therapy; Infant; Infant, Newborn; Infants; Low temperature; Male; Medical diagnosis; Pediatrics; Primary care; Primary Health Care; Quality control; Quality Improvement; Sepsis; Vital signs
• ISSN: 0009-9228; 1938-2707; 1938-2707
• DOI: 10.1177/00099228231200408

Hypothermia can be the first and only sign of sepsis in young infants, yet there is a paucity of standard recommendations for pediatric primary-care office management of those infants identified. The SMART aim of this study was to standardize the identification and care of infants age 0 to 49 days at risk of hypothermia in pediatric primary care by decreasing the percent of infants with temperatures ≤36.5°C from 24% to 10% within 2 years. Over the course of this project, variation in documented temperatures ≤36.5°C decreased from 24% to 7% of encounters. Temperatures ≤36.5°C were documented for 951 infants or 13.4% (1078 of 8020 encounters). Of the 951 infants with temperatures ≤36.5°C, 96.1% were rewarmed in the office. Thirty-one patients ultimately required hospitalization. Application of quality improvement in a primary-care office decreased low temperatures by standardizing care, empowering staff, and triaging at-risk infants to the most appropriate level of care.