Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Rana El-Feghaly, MD, MSCI
Start Date
12-5-2025 12:45 PM
End Date
12-5-2025 1:00 PM
Presentation Type
Oral Presentation
Description
Background: 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.
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) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).
Results: We saw shifts in the outcome metric’s center line in Sept 23 and May 24 from 12.8% to 57% (Figure 3) with no change in balancing metric while our process metrics rose in usage. Similarly, the CAP center line had shifts at the same points in time, increasing from 13.4% to 56.3% (Figure 2). The independent ABRS control chart only has one shift in the centerline in Nov 23 from 5.1% to 67.0% (Figure 3).
Conclusions: 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. Our limitations derive from the number of prescribers utilized in the ED, the variability of the prescriber schedule, and their availability for further involvement within the project. Future cycles will focus on barrier mitigation and focusing on resident education since they are the most common group of prescribers
Included in
Emergency Medicine Commons, Infectious Disease Commons, Patient Safety Commons, Pediatrics Commons, Quality Improvement Commons
Reducing Antibiotic Duration for Pneumonia and Sinusitis in the Emergency Department: A Quality Improvement Approach
Background: 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.
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) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).
Results: We saw shifts in the outcome metric’s center line in Sept 23 and May 24 from 12.8% to 57% (Figure 3) with no change in balancing metric while our process metrics rose in usage. Similarly, the CAP center line had shifts at the same points in time, increasing from 13.4% to 56.3% (Figure 2). The independent ABRS control chart only has one shift in the centerline in Nov 23 from 5.1% to 67.0% (Figure 3).
Conclusions: 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. Our limitations derive from the number of prescribers utilized in the ED, the variability of the prescriber schedule, and their availability for further involvement within the project. Future cycles will focus on barrier mitigation and focusing on resident education since they are the most common group of prescribers
