Program Schedule

A Quality Improvement Initiative to Decrease Unnecessary Streptococcal Antigen Testing in an Urban Pediatric Emergency Department

Session: Poster Abstract Session: Diagnostic Microbiology: Blood Culture Methodology/Clinical Utilization
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • GAS QI Poster-2014 .pdf (1.5 MB)
  • Background: Acute pharyngitis is a common complaint in the pediatric emergency department (ED).  Group A beta-hemolytic streptococcus (GAS) accounts for 15-30% of childhood pharyngitis. Previous investigation revealed that 64% of streptococcal testing performed in our ED during peak season was not clinically indicated. The objective was to optimize diagnostic and treatment decisions in children with pharyngitis in the ED using quality improvement (QI) methods. 

    Methods: The first plan-do-study-act (PDSA) cycle included a multi-tiered educational approach (daily huddles, lecture, and closed circuit television) of nurses, physicians, and nurse practitioners targeting recent testing guidelines and the current hospital testing protocol. Demographics, clinical features, and rapid antigen test (RADT) results were collected from 20 patients weekly from 3/1/14-4/30/14. Adherence to the current protocol was determined by chart review and compared to pre-intervention data. 

    Results:   A total of 128 patients had RADT testing; 45 (35%) were positive. Reflex throat culture was positive in 11 (13%) of the negative RADT isolates. Of those with a positive RADT, 25 (56%) patients did not meet testing criteria; 19 (76%) had viral symptoms (e.g. cough, congestion, rhinorrhea), 10 (40%) had no sore throat, and/or one (4%) were <3 years old. Of those with a negative RADT, 62/82 (75%) patients did not meet testing criteria; 48 (77%) had viral symptoms, 28 (45%) had no sore throat, and/or four (6%) were <3 years old. No decrease in unnecessary testing was seen between the pre-intervention and post-intervention time frames (p=0.43). Antibiotics were prescribed for three (4%) patients with negative RADT and culture result. Twenty-nine patients (23% overall) who did not meet testing criteria, but had a positive RADT (n= 25) or culture (n=4), received an antibiotic. 

    Conclusion: The majority of GAS testing in our ED continues to be unnecessary, and 25% of patients received unnecessary antibiotic treatment. Educational interventions targeting all healthcare providers did not change clinical testing decision-making. The next QI intervention will include implementing a new GAS testing protocol for the ED and ordering restrictions.

    Ashley Bruns, DO1, Cameron Myers2, Brian Lee, MPH, PhD3, Megan Gripka, MLS (ASCP) SM4, Kristen Shaw, BS4, Sarah Weston, MD5, Andrew Loehr, RN, MSN, CPNP6, Robyn Kleweno, RN6 and Angela Myers, MD, MPH3, (1)Pediatrics, Children's Mercy Hospital, Kansas City, MO, (2)Pediatrics, University of Missouri Kansas City-School of Medicine, Kansas City, MO, (3)Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (4)Microbiology, Children's Mercy Hospital-Kansas City, Kansas City, MO, (5)Pediatrics, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (6)Emergency Medicine, Children's Mercy Hospital-Kansas City, Kansas City, MO


    A. Bruns, None

    C. Myers, None

    B. Lee, None

    M. Gripka, None

    K. Shaw, None

    S. Weston, None

    A. Loehr, None

    R. Kleweno, None

    A. Myers, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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