Background: National guidelines recommend influenza testing and/or empiric treatment for children hospitalized with influenza-like illness (ILI) during the influenza season. Using quality improvement methods, we sought to increase influenza testing and/or treatment for children admitted to our hospital medicine service with ILI from a baseline of 60% to a goal of 90% during a single influenza season.
Methods: We targeted several key drivers of appropriate testing, including provider buy-in and awareness of national recommendations for influenza testing and treatment, local influenza activity, and knowledge of project goals and progress. Interventions targeting the key drivers were tested using multiple plan-do-study-act cycles among emergency and hospital medicine providers. Adopted interventions included an awareness module, biweekly ILI fliers, and failure tracking with provider feedback. Admissions for ILI were reviewed weekly once influenza activity was detected locally according to state surveillance data. Failures were defined as the lack of influenza testing and/or treatment during the first 24 hours of hospitalization for any child with ILI (fever plus any respiratory symptom) unless another pathogen was detected (eg, RSV) or a clear alternative diagnosis (eg, retropharyngeal abscess) was present. A run chart was used to track progress using established improvement methods.
Results: Within 3 months, appropriate testing and/or treatment increased from 60% to 91%, and was sustained for the remainder of the influenza season (Figure). Overall, an influenza test was performed in 221 of the 374 eligible ILI admissions (59%). Of these, 23 (10%) tested positive for influenza. Among those with medication data available (n=255), antivirals were prescribed in 18 children with ILI, including 100% of those with a positive influenza test (n=13).
Conclusion: Following a quality improvement initiative, influenza testing and/or treatment increased to more than 90% among children hospitalized with ILI at our institution during the influenza season. Our initiative also likely improved recognition of influenza and increased opportunities for treatment. Future work will focus on wider implementation and eliminating unwarranted variation.
L. Riley, None
M. L. Lindegren, None
W. Schaffner, None
J. D. Chappell, None
D. J. Williams, None