QI Initiatives Target Overuse of Antibiotics and a Bronchiolitis Treatment

Posted on April 29, 2024

In the May 2024 Pediatrics, three national quality improvement collaborations are described in articles focusing on ways to improve the pediatric medical experience. All three initiatives were supported by the Pediatric Acute & Critical Care Quality Network (formally known as the VIP Network), a program of the American Academy of Pediatrics, and will be featured in articles published online April 29. The article, “A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections,” analyzed 118 hospitals enrolled in the collaborative and found an increase in the appropriate use of antibiotics to treat community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI). The study, “Multicenter Quality Collaborative to Reduce Overuse of High Flow Nasal Cannula in Bronchiolitis,” noted the overuse of high-flow nasal cannula, a method of delivering oxygen to patients. The program led to reduced use of high-flow nasal cannula initiation and duration of treatment in bronchiolitis patients admitted to 71 hospitals without an increase in emergency department services or hospital length of stay. A third article, “Improving Guideline-Concordant Care for Febrile Infants through a Quality Improvement Initiative,” examined the impact of a quality improvement collaborative on adherence to specific recommendations within the AAP Clinical Practice Guideline for well-appearing febrile infants aged 8-60 days. The study of 17,708 infants found significant improvements in adherence to several recommendations from the AAP clinical guidance across 103 participating sites. Quality improvement programs typically offer access to resources that are not widely available, including subject matter and application experts, collective learning opportunities, accelerated knowledge dissemination, and implementation success. The local efforts can be duplicated and applied at other settings to reach more children, including the most vulnerable, according to a solicited commentary also published on April 29, “We Need it All in Quality Improvement: Local Change, Collaboration, and an Equity Lens.”