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Description

Background: Limiting antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it reduces unnecessary antibiotic exposure. In our emergency department (ED), >90% of respiratory infections are treated with first-line guideline-recommended antibiotics; however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). Institutional guidance recommends shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however only 13% of discharged ED patients receive the recommended duration. Objective: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25. Design/Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24). Results: We saw shifts in the outcome metric’s center line in Sept 23 and May 24 from 13% to 55% with no change in balancing metric (Figures 1A-B). Discussion: We saw a reduction in antibiotic durations for CAP and ABRS with development of standard order set, Quick discharge order set, and prescriber education interventions. Future cycles will focus on barrier mitigation and focusing on resident education since they are the most common prescribers.

Publication Date

4-25-2025

Disciplines

Emergency Medicine | Pediatrics

When and Where Presented

Presented at the Academic Pediatric Association 14th Annual Quality Improvement Research Conference; April 25, 2025; Honolulu, Hi

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

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