Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative

Amanda R. Dube, Amy R. Zhao, Chioma U. Odozor, Katherine Jordan, Favour O. Garuba, Angela Kennedy, Angela Niesen, Rebecca C. Kyrouac, Danielle Stortz, Hafsa Lodhi, Jason G. Newland, Oloruntosin Adeyanju

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. The American Academy of Pediatrics (AAP) recommends shorter antibiotic courses and wait-and-see prescriptions (WSPs) for healthy children with mild-to-moderate AOM. Still, clinicians do not consistently prescribe these in pediatric emergency units (EUs). Methods: We performed a quality improvement project to improve antibiotic prescribing in a tertiary pediatric EU over 16 months, focusing on shorter prescription durations and WSPs. We assessed AOM management via chart review, then implemented interventions, including clinician education, a guideline card, visual reminders, and updated emails. In addition, we contacted a percentage of families after their visit to assess their child's outcome and parental satisfaction. Results: Our baseline data showed that only 39% of patients prescribed antibiotics were prescribed an appropriate duration based on age and estimated AOM severity, and only 3% were prescribed WSPs. Via 2 plan-do-study-act (PDSA) cycles, we increased the percentage of patients who received appropriate antibiotics to an average of 67%, sustained for >6 months. Follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. We did not see a substantial increase in WSPs. Conclusions: AOM management in our children's hospital's EU was often inconsistent with AAP guidelines. Two PDSA cycles improved the rate of appropriate duration antibiotics, and follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. The next steps involve developing an order set and implementing individualized feedback.

Original languageEnglish
Pages (from-to)E625
JournalPediatric Quality and Safety
Volume8
Issue number1
DOIs
StatePublished - Jan 16 2023

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