Abstract:
Background: Quality improvement methodology has enabled application of research based clinical recommendations to patient care to standardize management and curtail cost. Utilizing acute otitis media (AOM) AAP guidelines, we describe one healthcare system’s 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 focused on treatment duration (TD).
Methods: 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 emergency department were instructed on appropriate TD based on age. Aggregate and individual data was shared anonymously, and ongoing education was provided. Statistical process control (P) chart was utilized to monitor performance.
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: QI tools including learnings from Plan-Do-Study-Act (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. PDSA cycles were utilized to scale the success to multiple care settings across several states at an enterprise level. This is being analyzed.
