1915. Implementation of a Quality Improvement Initiative to Optimize Testing and Improve Antibiotic Utilization for Group A Streptococcal Pharyngitis in a Community Pediatric Practice
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall

Background: Acute pharyngitis is a common diagnosis in ambulatory pediatrics.  While group A streptococcus (GAS) is the most common bacterial cause of acute pharyngitis in children, the vast majority of cases are caused by viruses.  Nationally, antibiotics are prescribed in excess of the maximum expected prevalence of GAS pharyngitis.  The Infectious Diseases Society of America (IDSA) clinical practice guideline for GAS pharyngitis recommends strict criteria for testing to avoid misdiagnosis of colonized children.  The majority of testing (~60%) for GAS pharyngitis in this pediatric practice did not meet IDSA criteria prior to intervention. Methods: Charts were included from patients with a procedure code for GAS rapid antigen detection test (RADT).  Retrospective chart review was performed.  The outcome measure, unnecessary GAS testing, was defined as any patient meeting 1 or more of the following criteria:  1) age < 3 years 2) presence of viral symptoms 3) absence of sore throat 4) absence of expected GAS pharyngitis exam findings.  A convenience sample of 20 charts per month was included for October 1, 2013-January 31, 2016.  Charts were excluded if RADT results were unknown.  Iterative Plan-Do-Study-Act cycles were completed.  Interventions include: 1) educational webinar 2) review of current state with clinic providers and development of new office procedure 3) updated data report to providers. Results: Over the project period, 60.3% of GAS pharyngitis testing was unnecessary (Figure 1).  The primary reason for unnecessary testing was presence of viral symptoms, followed by absence of sore throat.  The unnecessary tests resulted in 87 antibiotic prescriptions that were not indicated.  Lower proportions of unnecessary testing were seen following Intervention #2. Conclusion: The majority of GAS pharyngitis testing in this practice was not clinically indicated prior to intervention.  Testing for GAS in children when it is not clinically indicated can result in unnecessary antibiotic exposure.  Discussion of appropriate testing practices and adoption of new office procedures may decrease unnecessary testing.  Further tests of change are needed to determine if sustainable improvement was made.  Future tests of change will be designed based on feedback from the third intervention.

Figure 1. Control chart of outcome measure

Laura Norton, MD, Infectious Diseases, Children's Mercy Hospital, Kansas City, MO, Brian Lee, MPH, PhD, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, Lory Harte, PharmD, CPHQ, Children's Mercy Hospital, Kansas City, MO and Angela Myers, MD, MPH, FPIDS, Children's Mercy Hospital, Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO

Disclosures:

L. Norton, None

B. Lee, None

L. Harte, None

A. Myers, None

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