优化儿科急诊中肺炎和鼻窦炎的抗生素疗程

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中文摘要

目的： 国家和国际指南的更新现在建议将无并发症的社区获得性肺炎（CAP）的抗生素疗程缩短至3至5天，急性细菌性鼻窦炎（ABRS）缩短至5至7天。我们的目标是在2025年7月之前，将因CAP或ABRS从急诊科出院的儿童中接受最佳抗生素疗程的比例从13%提高到70%。
方法： 我们组建了一个多学科团队，并使用质量改进工具，包括因果分析、驱动图和优先排序矩阵，以确定有影响力的干预措施。我们还调查了处方者对较短抗生素疗程的接受度。计划-执行-研究-行动（PDSA）循环包括实施新的临床路径（CP）、电子健康记录（EHR）更新以及教育处方者。我们的结局指标是接受CAP和ABRS推荐抗生素疗程的患者百分比。过程指标包括CP快速响应码的使用和CAP“快速出院”医嘱集的使用。平衡指标是14天内因相同诊断再次就诊的次数。
结果： 我们观察到结局指标中心线在2023年8月、2024年2月和2024年11月发生偏移，从13.1%升至64.8%。这些变化主要反映CAP疗程，因为它是更常见的诊断，尽管在此期间ABRS的短抗生素疗程也显示出类似的改善。过程指标随时间推移有所增加。平衡指标没有变化。
结论： 我们通过CP变更、EHR更新、处方者教育和反馈以及资源分配，显著改善了CAP和ABRS的抗生素处方疗程。

英文摘要

OBJECTIVE: Updates to national and international guidelines now recommend shortening antibiotic durations to 3 to 5 days for uncomplicated community-acquired pneumonia (CAP) and 5 to 7 days for acute bacterial rhinosinusitis (ABRS). We aimed to increase the percentage of children discharged home from the emergency department with CAP or ABRS who were treated with an optimal antibiotic duration from 13% to 70% by July 2025.
METHODS: We assembled a multidisciplinary team and used quality improvement tools, including cause-and-effect analysis, driver diagram, and prioritization matrix, to identify impactful interventions. We also surveyed prescriber comfort with shorter antibiotic durations. Plan-Do-Study-Act cycles included implementing new clinical pathways (CP), electronic health record (EHR) updates, and educating prescribers. Our outcome metric was the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics included use of CP Quick Response codes and CAP "Quick-Discharge" order sets. Balancing metric was the number of return visits with the same diagnosis within 14 days.
RESULTS: We saw shifts in the outcome metric center line in August 2023, February 2024, and November 2024 from 13.1% to 64.8%. These changes primarily reflected CAP duration because it was the more common diagnosis, although ABRS short antibiotic durations showed similar improvement during this time frame. Process metrics showed an increase over time. There was no change in balancing metric.
CONCLUSION: We significantly improved antibiotic prescription durations for CAP and ABRS through CP changes, EHR updates, prescriber education and feedback, and resource distribution.