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A Learning Collaborative to Improve Antibiotic Use for Otitis Media and Pharyngitis in Pediatric Urgent Care Clinics
Jennifer Monti1, Brittany Jennings1, Makayla Schissel2
1Department of Child Health Finance and Quality, American Academy of Pediatrics; Itasca IL.
Insights
A quality improvement collaborative increased delayed antibiotic use for acute otitis media (AOM) in pediatric urgent care clinics (UCCs). This initiative focused on appropriate antibiotic prescribing for AOM and pharyngitis, enhancing patient care.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Quality improvement in healthcare
Background:
- Acute otitis media (AOM) and pharyngitis are common pediatric infections.
- Appropriate antibiotic prescribing is crucial to combat antimicrobial resistance.
- Pediatric urgent care clinics (UCCs) play a significant role in managing these conditions.
Purpose of the Study:
- To enhance antibiotic prescribing practices for AOM and pharyngitis in pediatric UCCs.
- To increase the appropriate use of delayed antibiotic prescriptions for nonsevere AOM.
- To improve adherence to guidelines for group A streptococcus (GAS) testing in pharyngitis.
Main Methods:
- A multicenter quality improvement collaborative involving 13 UCCs and 84 clinicians.
- Utilized national guidelines to define criteria for nonsevere AOM and appropriate antibiotic use.
- Implemented monthly learning sessions and clinician commitment to track encounters and interventions.
Main Results:
- First-line antibiotic use for AOM and GAS pharyngitis remained stable (75.7% and 79.9%).
- Documentation of delayed antibiotic criteria for AOM increased significantly (26%-27% to 83%).
- Use of delayed antibiotics for AOM rose from 32%-42% to 70%; GAS testing remained high (>96%).
Conclusions:
- A collaborative approach effectively increased the use of delayed antibiotics for AOM in pediatric UCCs.
- The initiative highlights the potential of quality improvement collaboratives in optimizing antibiotic stewardship.
- Further efforts are needed to sustain and expand these improvements in pediatric urgent care settings.
Objective:
To increase the percentage of first-line antibiotics prescribed for acute otitis media (AOM) and pharyngitis, the percentage of treated pharyngitis with a positive group A streptococcus (GAS) test, and the percentage of nonsevere AOM patients prescribed delayed antibiotics in pediatric urgent care clinics (UCCs).
Methods:
The American Academy of Pediatrics Section on Urgent Care Medicine and Pediatric Acute and Critical Care Quality Network developed a multicenter quality improvement collaborative. We used national guidelines to determine criteria for nonsevere AOM and first-line antibiotics for AOM and pharyngitis. Participating UCCs committed at least 3 clinicians to submit 10 encounters for each diagnosis per month during the intervention period (October 2022 to June 2023). Clinicians signed commitment letters, participated in monthly learning sessions, and tested UCC-selected interventions.
Results:
We recruited 84 participants from 13 UCCs. Participants submitted 5017 AOM encounters and 3762 pharyngitis encounters. The use of first-line antibiotics for AOM and GAS pharyngitis remained stable at 75.7% and 79.9%, respectively, throughout the project. The documentation of delayed antibiotic criteria increased from a range of 26%-27% at baseline to 83% [5.42% per month (95% CI: 4.03-6.81)]. This corresponded to an increase in use of delayed antibiotics for AOM from a range of 32%-42% at baseline to 70% by the end of the intervention period [2.53% per month (95% CI: 0.57-4.48)]. Rates of GAS testing before treating pharyngitis increased during baseline and remained high (>96%) throughout the intervention period.
Conclusions:
This multicenter collaborative provided education and networking to increase the use of delayed antibiotics for AOM in pediatric UCCs.
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