Clinical decision making in paediatric otitis media: A pilot quality improvement study

Area of Science:

• Otolaryngology
• Pediatric Medicine
• Quality Improvement Science

Background:

• Paediatric otitis media management requires adherence to clinical guidelines.
• The American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) provides guidelines for tympanostomy tube insertion in children.
• Local practice variations can impact optimal patient care.

Purpose of the Study:

• To enhance the local management of paediatric otitis media.
• To improve adherence to the 2022 AAO-HNS Clinical Practice Guideline for Tympanostomy Tubes in Children.
• To evaluate the impact of an educational intervention on tympanostomy tube prescription practices.

Main Methods:

• A SQUIRE 2.0 compliant quality improvement study was conducted.
• Paediatric otitis media management was audited against AAO-HNS guidelines, focusing on tympanostomy tube decisions.
• An educational session was delivered, followed by re-evaluation of practice.

Main Results:

• Initial guideline adherence for tympanostomy tubes was 76.1%.
• Following an educational intervention, adherence significantly improved to 95.2% (p=0.02).
• Reasons for non-compliance included effusion duration, lack of fluid evidence, and failure to meet criteria.

Conclusions:

• Focused educational interventions can improve guideline adherence in paediatric otitis media management.
• Continuous re-evaluation of clinical practice is crucial for ensuring guideline-compliant care.
• Optimizing tympanostomy tube decisions improves management of paediatric otitis media.