Reducing streptococcal testing in patients,3 years old in an emergency department

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DOI: 10.1542/peds.2019-0174


Copyright © 2019 by the American Academy of Pediatrics

BACKGROUND: Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients,3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients,3 years of age. Our objective was to reduce RSTs in the ED in patients aged,3 years by 50% in 18 months.

METHODS: We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children,3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged,3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis.

RESULTS: The mean number of RSTs ordered per month in patients aged,3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project.

CONCLUSIONS: Our interventions led to a successful and sustained reduction of RSTs in patients aged,3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.

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