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. 2018 Sep 20;3(5):e105.
doi: 10.1097/pq9.0000000000000105. eCollection 2018 Sep-Oct.

Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia

Amanda J Rogers  1 , Patricia S Lye  1 , Daisy A Ciener  2 , Bixiang Ren  3 , Evelyn M Kuhn  3 , Andrea K Morrison  1
Affiliations

Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia

Amanda J Rogers et al. Pediatr Qual Saf. .

Abstract

Background: National guidelines for pediatric community-acquired pneumonia (CAP) contain recommendations regarding diagnostic testing including chest radiographs (CXRs), complete blood counts (CBCs), and blood cultures. Local data indicated that our institution was not delivering care at standards outlined by these guidelines. This project aimed to decrease CXRs for children with CAP discharged from the emergency department (ED) by 10% and decrease CBCs and blood cultures for patients hospitalized with uncomplicated CAP by 20% within 1 year.

Methods: This single-site quality improvement initiative targeted otherwise healthy children 3 months to 18 years who presented to the ED with uncomplicated CAP at a free-standing academic children's hospital. A quality improvement team performed a series of interventions including guideline implementation, data sharing, and annual education. Process measures included CXR, CBC, and blood culture rates. Balancing measures included the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and ED and hospital return rates. The team used statistical process control charts to plot measures.

Results: There was special cause improvement with a desirable downward shift in testing that correlated with the project's interventions. The percentage of CXRs for discharged patients decreased from 79% to 57%. CBCs and blood cultures for hospitalized patients decreased from 30% to 19% and 24% to 14%, respectively. Balancing measures remained unchanged.

Conclusions: We used elements of quality improvement methodology to reduce testing for uncomplicated CAP without impacting the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and reutilization rates.

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Figures

Fig. 1.
Fig. 1.
ICD-9 inclusion and exclusion criteria.
Fig. 2.
Fig. 2.
P-chart: percentage of discharged pneumonia patients with CXR ordered. P-chart for primary process measure, percentage of pneumonia patients providers discharged from the ED after having a chest x-ray ordered during the encounter. LCL, lower control limit; UCL, upper control limit.
Fig. 3.
Fig. 3.
P-chart: percentage of admitted patients with complete blood count ordered. P-chart for primary process measure of the percent of pneumonia patients admitted from ED with a complete blood count ordered in the ED. LCL, lower control limit; UCL, upper control limit.
Fig. 4.
Fig. 4.
P-chart: percentage of admitted patients with blood culture ordered. P-chart for primary process measure of the percentage of pneumonia patients admitted from ED with a blood culture ordered in the ED. LCL, lower control limit; UCL, upper control limit.
See this image and copyright information in PMC

References

    1. Keren R, Luan X, Localio R, et al. ; Pediatric Research in Inpatient Settings (PRIS) Network. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med. 2012;166:1155–1164.. - PubMed
    1. Hersh AL, Shapiro DJ, Newland JG, et al. Variability in pediatric infectious disease consultants’ recommendations for management of community-acquired pneumonia. PLoS One. 2011;6:e20325. - PMC - PubMed
    1. Brogan TV, Hall M, Williams DJ, et al. Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31:1036–1041.. - PMC - PubMed
    1. Bradley JS, Byington CL, Shah SS, et al. ; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:617–630.. - PMC - PubMed
    1. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. 1991;265:365–369.. - PubMed