Pediatric Hospitalist University of Colorado / Children's Hospital Colorado Aurora, Colorado, United States
Background: Antibiotics are overused for children with community-acquired pneumonia (CAP). Chest radiograph (CXR) is the most used diagnostic tool, yet report terminology varies, and certain terms such as “pneumonia” may contribute to antibiotic overuse. Objective: Implement a radiology-based intervention to decrease the percent of children with a respiratory illness and CXR performed who receive antibiotics by 20% (from baseline rate of 50%) over one respiratory season. Design/Methods: We recruited a multidisciplinary team with expertise in CAP, radiology, antibiotic stewardship, and diagnostic safety. Using Model for Improvement framework, we identified key drivers of antibiotic overuse in pediatric pneumonia such as variability in radiologic terminology and underrecognition of CXR limitations in establishing CAP etiology. Interventions focused on standardizing radiologists’ terminology for CXR impressions. We focused on 1) developing a list of standard CXR impressions, 2) removing the term “pneumonia” and instead using “consolidation”, 3) adding an education statement highlighting CXR limitations in distinguishing viral and bacterial CAP, and 4) referencing our institutional CAP clinical pathway. Our study population includes non-medically complex, non-critically ill patients aged 3 months to 18 years with a CXR performed and diagnosis code for lower respiratory illness including CAP, bronchiolitis, influenza, and asthma in the emergency department, inpatient, or outpatient settings of a multi-site children’s hospital network from June 2023 to March 2024. Our primary outcome is the percent of patients who received at least one dose of antibiotics for CAP, based on the selection of mandatory institutional antibiotic order indications for “pneumonia/sinusitis” or “atypical pneumonia”. Balancing measures include rate of 7-day ED visit or readmission, chest tube placement, and length of stay. We will use statistical process control charts to evaluate outcomes over time. This project was approved by our institution’s Organizational Research Risk and Quality Improvement Review Panel.
