Reducing Antibiotic Duration for Pneumonia and Sinusitis in the Emergency Department: A Quality Improvement Approach

Authors

Joshua Saucedo, Children's Mercy Kansas CityFollow
Leslie Hueschen, Children's Mercy HospitalFollow
Amanda Nedved, Children's Mercy HospitalFollow
Marsha Dannenberg, Children's Mercy Kansas CityFollow
Patricia Phillips, Children's Mercy HospitalFollow
Jennifer Floyd, Children's Mercy Kansas CityFollow
Alaina N. Burns, Children's Mercy Kansas CityFollow
Rana El Feghaly, Children's Mercy Kansas CityFollow

Publication Date

4-2025

Files

Abstract

Background: Antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it helps to limit unnecessary antibiotic exposure while continuing to provide appropriate care for infections. In our emergency department (ED), clinicians are using first-line guideline-recommended antibiotics as an appropriate choice for most patients (per our ASP report tracking), however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). National guidelines recommend shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however currently only 22% of patients discharged from our ED receive the recommended duration. Objective: Our aim is to increase percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (5 days or less for CAP, 7 days or less for ABRS) from 22% to 70% by July 2025, while assessing for differences in care based on demographic and socioeconomic factors. Design/Methods: A multidisciplinary team (infectious diseases physicians, ED and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in December 2023. Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP or ABRS; data trends analyzed monthly and process changes implemented according to the SPC Out of Control Process Western Electric rule set. Process metrics include use of order set, quick discharge order set, and QR code. Balancing metric is the number of return visits with the same discharge diagnosis within 14 days. Utilizing cause-and-effect diagram, driver diagram (Figure 1), and PICK chart (Figure 2), we identified possible interventions. Plan-Do-Study-Act cycles so far have included implementation of new internal CAP, updates to electronic medical record and quick discharge order sets. A survey of prescriber comfort with shorter duration identified barriers and provided education, which has led to posting evidence for lower duration treatment to prescribers in their workrooms and developing new ABRS CPG. Results: We have shifts in the central line of our overall outcome in August 2023, May and July 2024 to 65.4% with no change in balancing metric (Figures 3A-CQBS, annotated with PDSA cycles). Discussion: We have seen a reduction in the duration of antibiotics for CAP and ABRS with electronic medical record and prescriber education interventions. Future cycles will focus on barrier mitigation and increased data transparency, with huddle board reminders and positive encouragement to providers.

Disciplines

Emergency Medicine | Pediatrics

Notes

Presented at the 2025 Pediatric Academic Societies (PAS) Annual Meeting; Honolulu, HI; April 24-28, 2025.

Recommended Citation

Saucedo, Joshua; Hueschen, Leslie; Nedved, Amanda; Dannenberg, Marsha; Phillips, Patricia; Floyd, Jennifer; Burns, Alaina N.; and El Feghaly, Rana, "Reducing Antibiotic Duration for Pneumonia and Sinusitis in the Emergency Department: A Quality Improvement Approach" (2025). Posters. 452.
https://scholarlyexchange.childrensmercy.org/posters/452