The Management of the Febrile Under Six Week old Baby in New Zealand Emergency Departments

Abstract

Aim: The aim of this study was 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 New Zealand wide anonymous survey of New Zealand emergency departments 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 emergency department within New Zealand of all febrile under six week old babies presenting within one year. This examined the process involved during the babies management within the emergency department including the clinician completing the investigations, time to septic screen completion, and variables effecting this time. Results: The reported definition of fever from participating emergency departments ranged from 37.5℃ to 38.1℃. Of the 8 completed survey responses, 50% (n=4) of the emergency departments reported having a guideline for the management of the febrile under six week old baby. Nurses were able to complete urine catheterisation in 63% (n=5) of the departments, however were able to initiate and complete the other components of the septic screen less than a quarter of the time. Of the 979 under six week old presentations to the single site emergency department within one year, 58 were identified as febrile 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 with a range of (75-367) minutes. Triage score, room placement and age of the patient had no effect on time to septic screen completion. Conclusions: The current management of the studied population varies between New Zealand emergency departments and nurse involvement in the majority of septic screen investigations is minimal. Nearly half of febrile under six week old babies do not receive a complete septic screen. Time to full septic screen completion is almost three hours. Further studies are required to investigate why nearly half of patients do not receive a complete septic screen, the rationale for the current time to septic screen completion, and what factors influence this. Standardisation of guidelines and utilisation of nurses as the procedural clinician during septic screen components should be considered in future guidelines and protocols.