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Reducing Streptococcal Testing in Patients <3 Years Old in an Emergency Department
Tania Ahluwalia1, Shobhit Jain2, Laura Norton3
1Children's Mercy Hospital, Kansas City, Missouri; and tahluwalia@childrensnational.org.
Insights
Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in children under 3. A project successfully reduced RSTs by 52% in 10 months, improving healthcare efficiency.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Diagnostics
- Clinical Quality Improvement
Background:
- Group A Streptococcus pharyngitis is uncommon in children under 3 years old.
- Rapid streptococcal tests (RSTs) are not routinely indicated for this age group.
- Inappropriate testing increases healthcare costs and unnecessary antibiotic exposure.
Purpose of the Study:
- To reduce the number of RSTs performed in a pediatric emergency department for patients under 3 years of age by 50% within 18 months.
- To decrease unnecessary diagnostic testing and antibiotic use in young children.
Main Methods:
- A quality improvement project was initiated in an urban, tertiary pediatric emergency department.
- Stakeholder surveys identified factors contributing to RST use.
- Interventions were implemented, and data on RSTs, family complaints, and return visits were collected weekly.
- Statistical process control was used for data analysis.
Main Results:
- The mean number of RSTs ordered per month for patients under 3 years declined by 52% within 10 months.
- Nurse practitioners ordered the majority of tests (62%), primarily for children aged 25-36 months (66%).
- One family grievance was reported, with no patient complications attributed to the project.
Conclusions:
- The implemented interventions successfully and sustainably reduced RSTs in patients under 3 years.
- A local clinical practice guideline was developed.
- The project's success led to its expansion into other acute care settings.
Background:
Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients <3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients <3 years of age. Our objective was to reduce RSTs in the ED in patients aged <3 years by 50% in 18 months.
Methods:
We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children <3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged <3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis.
Results:
The mean number of RSTs ordered per month in patients aged <3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project.
Conclusions:
Our interventions led to a successful and sustained reduction of RSTs in patients aged <3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.
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