Increasing Adherence to Acute Otitis Media Treatment Duration Guidelines using a Quality Improvement Approach

Uhl, Bethany D; Boutzoukas, Angelique E; Gallup, Nathaniel; Patrick, Michael; Stultz, Jerry; Porter, Courtney; Watson, Joshua R.

doi:10.1097/pq9.0000000000000501

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…However, we improved prescription durations for children ≥ 2 years old via low-cost interventions, including education, guideline card development, minor electronic medical record (EMR) adjustments, visual reminders, and email feedback. These changes are similar to those seen in other similar studies 16 and were sustained for 6 months of continued monitoring after we discontinued update emails or promotional activities. The improvement also persisted despite the drop and rebound in EU volumes related to the COVID-19 pandemic.…”

Section: Discussionsupporting

confidence: 87%

“…Our success in increasing appropriate duration prescriptions is similar to that reported in a recent QI project in an UC setting. 16 The present study shows feasibility in a different setting. Other strengths of the present study include that our chart review allowed for differentiating between patients with nonsevere versus severe AOM, and our follow-up phone call strategy allowed us to assess for parental satisfaction and acute care visits to all sites, including those sites outside of our health system.…”

Section: Discussionmentioning

confidence: 65%

“…This finding is similar to previous studies, which found equivalent outcomes with 5–7-day courses compared with 10-day courses for children ≥ age 2, 7 , 14 and no increase in return visits. 16 This observation suggests that shorter prescription lengths do not adversely impact patient outcomes or experience. However, our study was not adequately powered to detect rare adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 15 Of relevance, a recent study showed the feasibility of improving prescription duration in an urgent care (UC) without an increase in 30-day return visits. 16 …”

Section: Introductionmentioning

confidence: 99%

“…11,15 Of relevance, a recent study showed the feasibility of improving prescription duration in an urgent care (UC) without an increase in 30-day return visits. 16 Another approach to reducing antibiotic use recommended by the AAP AOM guidelines is wait-and-see prescriptions (WSPs). In this scenario, the clinician instructs the parent/caregiver only to fill the prescription if their child fails to improve within 2-3 days.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Improving Prescribing for Otitis Media in a Pediatric Emergency Unit: A Quality Improvement Initiative

Dube

Zhao

Odozor

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. The American Academy of Pediatrics (AAP) recommends shorter antibiotic courses and wait-and-see prescriptions (WSPs) for healthy children with mild-to-moderate AOM. Still, clinicians do not consistently prescribe these in pediatric emergency units (EUs). Methods: We performed a quality improvement project to improve antibiotic prescribing in a tertiary pediatric EU over 16 months, focusing on shorter prescription durations and WSPs. We assessed AOM management via chart review, then implemented interventions, including clinician education, a guideline card, visual reminders, and updated emails. In addition, we contacted a percentage of families after their visit to assess their child’s outcome and parental satisfaction. Results: Our baseline data showed that only 39% of patients prescribed antibiotics were prescribed an appropriate duration based on age and estimated AOM severity, and only 3% were prescribed WSPs. Via 2 plan-do-study-act (PDSA) cycles, we increased the percentage of patients who received appropriate antibiotics to an average of 67%, sustained for >6 months. Follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. We did not see a substantial increase in WSPs. Conclusions: AOM management in our children’s hospital’s EU was often inconsistent with AAP guidelines. Two PDSA cycles improved the rate of appropriate duration antibiotics, and follow-up phone calls suggested no difference in satisfaction or need for nonroutine follow-up care based on prescription length. The next steps involve developing an order set and implementing individualized feedback.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

“… 11 , 15 Of relevance, a recent study showed the feasibility of improving prescription duration in an urgent care (UC) without an increase in 30-day return visits. 16 …”

Section: Introductionmentioning

confidence: 99%