A Comprehensive Approach to Pediatric Pneumonia: Relationship Between Standardization, Antimicrobial Stewardship, Clinical Testing, and Cost

Objective: In September 2012, our institution implemented an emergency department (ED) and inpatient pathway for community-acquired pneumonia (CAP) based on national guideline recommendations. The objective of this study was to determine the relationship between standardizing ED and inpatient care for CAP and antimicrobial stewardship, clinical testing, and cost. Methods: We used descriptive statistics, statistical process control, and interrupted time series analysis to analyze measures 12 months before and after implementation. Results: Six hundred thirty-two patients were included. We found an immediate sustained increase in narrow-spectrum antibiotic (ampicillin) use from a baseline of 8-54%. There was a shift toward more guideline-recommended diagnostic testing with an increase in blood cultures and respiratory viral testing among admitted patients (35-63% and 52-84%, respectively). We identified no significant change in ED chest radiography use, mean ED length of stay (LOS), percentage of CAP admissions, or mean inpatient LOS. Costs of care for admitted patients and for patients discharged from the ED were unchanged. Conclusions: Standardizing care for ED and inpatient management of CAP led to immediate and sustained improvements in antimicrobial stewardship and guideline-recommended testing without significantly affecting costs.