A quality improvement (QI) initiative implemented at five community hospitals was associated with increased prescribing of narrow-spectrum antibiotics for pediatric pneumonia, a team of researchers from Harvard Medical School reported yesterday in Pediatrics.
The initiative involved the creation of multidisciplinary teams at each hospital that were tasked with increasing narrow-spectrum antibiotic use (ampicillin or amoxicillin) from 60% to 80% in patients aged 3 months to 18 years presenting with a pneumonia diagnosis in the emergency department (ED).
After four collaborative meetings, the teams developed site-specific interventions that were implemented at 3-month intervals, including deployment of an evidence-based treatment guideline, educational sessions, and order-set modification. To evaluate the interventions, the teams collected monthly prescribing data for 1 year, compared those data with baseline data from the previous year, and added an additional year to assess the sustainability of the intervention.
The analysis included 1,641 patients—531 in the baseline period, 703 during the intervention phase, and 407 in the sustainment phase. The aggregated rate of narrow-spectrum antibiotic prescriptions for pediatric pneumonia rose from 60% during the baseline period to 78% during the intervention period, then rose to 92% during the sustainment phase. During the intervention period, narrow-spectrum antibiotic prescribing rates improved from 72% to 85% for pediatric physicians and from 53% to 70% for general emergency medicine providers, then climbed 93% and 91%, respectively, during the sustainment phase. No change in the 72-hour emergency department return rate was observed.
Our findings ... reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics.
The authors say improving use of narrow-spectrum antibiotics for pediatric pneumonia is particularly important in community hospitals, because they see 90% of pediatric emergency patients, and pneumonia is one of the most common diagnoses in pediatric emergency medicine.
"Our findings, in the setting of 5 pediatric EDs within community hospitals, reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics," they wrote.