title: Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia.
abstract: OBJECTIVE
  In August 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America published an evidence-based guideline for the management of community-acquired pneumonia (CAP) in children ≥3 months. Our objective was to evaluate if quality improvement (QI) methods could improve appropriate antibiotic prescribing in a setting without a formal antimicrobial stewardship program.
  
  
  METHODS
  At a tertiary children's hospital, QI methods were used to rapidly implement the Pediatric Infectious Disease Society/Infectious Disease Society of America guideline recommendations for appropriate first-line antibiotic therapy in children with CAP. QI interventions focused on 4 key drivers and were tested separately in the emergency department and on the hospital medicine resident teams, using multiple plan-do-study-act cycles. Medical records of eligible patients were reviewed weekly to determine the success of prescribing recommended antibiotic therapy. The impact of these interventions on our outcome was tracked over time on run charts.
  
  
  RESULTS
  Appropriate first-line antibiotic prescribing for children admitted with the diagnosis of CAP increased in the emergency department from a median baseline of 0% to 100% and on the hospital medicine resident teams from 30% to 100% within 6 months of introducing the guidelines locally at Cincinnati Children's Hospital Medical Center and has been sustained for 3 months.
  
  
  CONCLUSIONS
  Our study demonstrates that QI methods can rapidly improve adherence to national guidelines even in settings without a formal antimicrobial stewardship program to encourage judicious antibiotic prescribing for CAP.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA. lilliam.ambroggio@cchmc.org
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.forename: Joanna
authors.initials: J
authors.lastname: Thomson
authors.forename: Eileen
authors.initials: E
authors.lastname: Murtagh Kurowski
authors.forename: Joshua
authors.initials: J
authors.lastname: Courter
authors.forename: Angela
authors.initials: A
authors.lastname: Statile
authors.forename: Camille
authors.initials: C
authors.lastname: Graham
authors.forename: Brieanne
authors.initials: B
authors.lastname: Sheehan
authors.forename: Srikant
authors.initials: S
authors.lastname: Iyer
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards; D058996:Quality Improvement / Q000592:standards*; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic use; pediatric; pneumonia