Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia.

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Infectious Disease Management

Background:

• National guidelines recommend specific diagnostic tests for pediatric community-acquired pneumonia (CAP).
• Local data revealed that the institution's care for CAP did not align with established national guidelines.
• This initiative addressed the gap in diagnostic testing for pediatric CAP.

Purpose of the Study:

• To decrease the utilization of chest radiographs (CXRs) for children with CAP discharged from the emergency department (ED) by 10%.
• To reduce the use of complete blood counts (CBCs) and blood cultures for hospitalized patients with uncomplicated CAP by 20% within one year.

Main Methods:

• A quality improvement initiative was implemented at a children's hospital.
• Interventions included guideline dissemination, data sharing, and educational programs for healthcare providers.
• Statistical process control charts were used to monitor process and balancing measures.

Main Results:

• Significant reductions in diagnostic testing were observed, aligning with project goals.
• The rate of CXRs for discharged pediatric CAP patients decreased from 79% to 57%.
• Rates of CBCs and blood cultures for hospitalized CAP patients decreased from 30% to 19% and 24% to 14%, respectively.

Conclusions:

• Quality improvement methodologies effectively reduced diagnostic testing for uncomplicated pediatric CAP.
• These reductions were achieved without adverse impacts on patient diagnosis, antibiotic use, length of stay, or readmission rates.