Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics

To evaluate the effectiveness of multifaceted interventions in improving the use of safety net antibiotic prescriptions (SNAPs) for nonsevere acute otitis media (AOM).

We used quality improvement methodology to develop iterative Plan-Do-Study-Act cycles to increase the use of SNAP for nonsevere AOM in 3 pediatric urgent care centers from October 2021 to June 2023. Interventions included education, electronic health record changes, audits and feedback, and a time-limited financial incentive. We measured the percentage of eligible patients with AOM offered SNAP as our primary outcome. Our secondary outcome measured the percentage of SNAPs accepted. Our process measure evaluated the percent of SNAP eligibility documentation. Our balancing measure evaluated the percent of return visits for AOM within 14 days of initial diagnosis. We used control charts to evaluate special cause variation.

We reviewed 29 316 encounters. SNAP eligibility rates ranged from 27.6% to 45.5% over time. The percentage of eligible patients offered SNAP had 2 center line shifts, increasing from 7.2% to 49.7% as the rate of SNAP eligibility documentation had similar center line shifts increasing from 5.7% to 52.7%. There was no change in the rate of return visits for AOM of 4.3%. The number of SNAPs accepted each month had a center line shift increasing from a mean of 20 to 139.

The offering of SNAPs to patients with nonsevere AOM increased as clinician documentation of SNAP eligibility increased. This strategy could be implemented broadly to improve antibiotic stewardship.