Improving Antibiotic Prescribing Practices for Acute Otitis Media (AOM) in a Pediatric Tertiary Care Center Emergency Unit Free

Purpose/Objectives: Acute otitis media (AOM) is a commonly overtreated pediatric diagnosis. Since 2014, the American Academy of Pediatrics (AAP) has recommended shorter antibiotic courses for healthy children with mild-to-moderate AOM; specifically, 7 days for children ages 2-6 and 5 days for children > 6. While this strategy has been successfully implemented in some pediatric emergency units (EUs), studies have shown that 30-90% of children with AOM treated in pediatric EUs do not get care consistent with these guidelines. We aimed to assess via chart review and then intervene via multiple PDSA cycles to improve antibiotic prescribing practices in our tertiary care children’s hospital EU. Design/Methods: To assess baseline antibiotic prescribing behavior, we performed a chart review of children >/= 2 diagnosed with AOM in the St. Louis Children’s Hospital (SLCH) EU. Inclusion criteria were age >/= 2 years, diagnosis of any form of “otitis,” and discharged between 5/1/2019 and 7/31/2020. Exclusion criteria were otitis externa, medical complexity, concurrent other bacterial illness, ear tubes, or recent antibiotic use. Severity was estimated using fever, duration, exam findings, and presence of otorrhea/pain. A sampling of patients were called 14-60 days post-visit. PDSA cycle #1: we created guideline card with a flowchart for assessing and treating AOM, added a clickable button in the amoxicillin prescription order box for a 5-day, and provided education to providers. PDSA cycle #2: monthly progress emails to EU providers. PDSA cycle #3: discharge smartset for AOM that defaults to correct duration antibiotics based on age. Results: For baseline data, 642 charts were reviewed and 570 were included in the analysis. Only 41% of patients who were prescribed antibiotics were prescribed an appropriate duration based on age and estimated AOM severity. Throughout our first two PDSA cycles, we were able to increase the percentage of appropriate duration antibiotics to an average of 61%. 23 families answered follow-up questions by phone. There was no difference in satisfaction, resolution of symptoms at the time of phone call, or need for non-routine care for patients prescribed shorter (5-7 days) versus longer duration (10+ days) antibiotics. Our next step is to make an EU discharge order smartset which will default to appropriate duration antibiotics based on age. Conclusion/Discussion: AOM management in our hospital’s EU is often not consistent with AAP guidelines. Two PDSA cycles resulted in an improvement in the rate of appropriate duration antibiotic prescribing, based on both patient age and AOM severity, from 41% to 61%. Follow-up phone calls suggest no difference in satisfaction or need for non-routine follow-up care based on prescription length. Improving antibiotic prescribing improves quality of patient care by reducing unnecessary antibiotic days, which is important for decreasing healthcare costs as well as decreasing the development of antibiotic resistance.