P2.E082: Antimicrobial Stewardship in a Pediatric Emergency Department

Purpose/Objectives:: Quality improvement methodology has enabled application of research based clinical recommendations to patient care to standardize management and improve . Utilizing Acute otitis media (AOM) AAP guidelines, we describe emergency department’s (ED) strategy of using data feedback at the provider level and electronic health record integration to achieve antimicrobial stewardship. Prior to the QI initiative, AOM management varied widely between disciplines and between providers in the same discipline. The initiative aimed to increase the percentage of patients with AOM treated for the recommended treatment duration (TD ) from 61% to 80% over a 6-month period.

Design/Methods: Methods: This prospective, interrupted time series QI initiative was conducted at a tertiary-care, suburban, pediatric ED. A multidisciplinary team established regional guidelines mimicking national guidelines for the management of AOM. Electronic health records were queried on quarterly bases from 1/21-12/23 for ICD 10 diagnoses of AOM prior to the initiative and after implementation. Providers in one ED were instructed on appropriate TD based on age. Electronic Health Record enhancements were created to nudge appropriate TD. Aggregate and individual data was shared anonymously, and ongoing education was provided. Statistical process control was utilized to monitor performance.

Results:

Results: There were 1331 visits in the pre-implementation (1/21-12/21) and 4327 in the post-intervention (2/22-12/23) periods. Percent compliance with TD rose from 61% to 95% (Fig. 1). Steady improvement and sustained desired performance were achieved leading to a total of 8,200 antibiotic days avoided.

Conclusion/Discussion:

Conclusion: QI tools including learnings from PDSA cycles and frequent data sharing can powerfully lead to adoption of national guidelines for a ubiquitous pediatric diagnosis. Limitation of antibiotic use to recommended durations allows for antimicrobial stewardship.