Optimizing Duration of Therapy for Pediatric Patients with Uncomplicated Community-Acquired Pneumonia Discharged From an Emergency Department

Corresponding Author Paris Balfour-Ducharme, RPh, BCPPS, Department of Pharmacy, Dayton Children’s Hospital, 1 Children’s Plaza, Dayton, OH 45404, (937) 641-3031, balfourducharmep@childrensdayton.org Funding None to disclose. Conflict(s) of Interest Paris Balfour-Ducharme, no conflict; Jessica Foley, no conflict; Jeremy Larson, no conflict; J. Michael Klatte, no conflict. Background Considerable evidence supports treatment durations of five-to-seven days for uncomplicated community-acquired bacterial pneumonia (CAP). At Dayton Children’s Hospital, a clinical care pathway established in October 2020 and institutional guidance for empiric antimicrobials created in October 2021 advise seven days of antibiotics for uncomplicated CAP. Despite these resources, throughout 2022 a majority of discharge prescriptions from our emergency departments (EDs) were written for ten days. We aimed to increase the mean monthly percentage of seven-day discharge prescriptions for ED patients with uncomplicated CAP. Methods A baseline mean percentage of seven-day versus ten-day prescriptions was established for 2022 using a report generated through the electronic medical record (EMR) followed by retrospective chart review. A goal mean of 85% was introduced as a quality improvement measure in January 2023. A customized electronic dashboard was created to facilitate data collection over a two-year period. Data were incorporated into a p-chart monthly to assess the impact of interventions and identify opportunities for improvement. Results A shift in the baseline mean from 20% to 41% occurred in August 2022, prior to an EMR upgrade that improved formatting of the ED CAP discharge order set with a seven-day default duration for antibiotic prescriptions. A second shift from 41% to 64% was appreciated in August 2023 shortly after ED providers received education on order set utilization. A third shift from 64% to 88% was observed after the default duration for CAP antibiotics prescribed without using the ED CAP discharge order set was changed to seven days. Lastly, achievement of the 85% goal was added as a salary-based performance incentive for ED providers. Conclusion When combined with provider education, the increased utilization and optimization of electronic order sets with default antibiotic durations resulted in a mean percentage increase from 20% to 88% for seven-day versus ten-day ED discharge prescriptions for pediatric CAP. The coupling of duration-based antibiotic prescribing practices with monetary performance incentives may contribute to long-term sustainability.