A Multi-site Intervention for Pediatric Community Acquired Pneumonia in Community Settings

Abstract

Objectives

The majority of children with community acquired pneumonia (CAP) are primarily evaluated in community hospital emergency departments (EDs); however, studies on the management of pediatric CAP have largely targeted care provided in free-standing children's hospital EDs or inpatient settings. The objectives of this study were to examine whether implementation of a CAP pathway within three community hospital EDs and inpatient units improved process measures related to appropriate laboratory testing and antibiotic prescribing, and to compare performance on these measures between the community hospitals and a free-standing children's hospital.

Methods

Through a multi-disciplinary approach (including general emergency medicine (EM) providers, pediatric fellowship trained EM providers, and pediatric hospitalists), a CAP pathway was designed and implemented at three community hospitals in January and February 2016. Diagnostic and therapeutic process measures were collected using administrative data and medical record abstraction one year pre- and post-intervention. Chi-squared statistics and statistical process control P-charts were used to examine adherence to these process measures.

Results

Across the community hospitals, 544 patients pre-intervention and 321 patients post-intervention met inclusion criteria, with 290 children's hospital patients meeting criteria in the post-intervention period. Adherence to process measures increased post-intervention for appropriate laboratory testing, narrow spectrum antibiotic stewardship and macrolide stewardship by 10.8% (95% confidence interval [CI] 4.7, 16.9%), 8.3% (CI 21.5, 15.2%), and 3.1% (CI -4.3, 10.4%), respectively. Statistical process control P-charts demonstrated special cause variation immediately after implementation of the intervention in regards to appropriate laboratory testing.

Conclusion

Implementation of a CAP pathway through a multi-site community hospital intervention improved adherence to evidence-based recommendations for laboratory testing and antibiotic stewardship. Similar interventions may improve the quality of care for children with CAP on a population level, as community hospitals are where these patients are seen most frequently.

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