Emergency Medicine Commons^™

Health Disparities For Pneumonia And Sinusitis Antibiotic Treatment In The Emergency Department, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Rana El Feghaly Md

Posters

Optimal antibiotic selection and duration are pillars of antimicrobial stewardship efforts. In our emergency department (ED), >80% of community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS) are treated with first-line (FL) guideline-concordant antibiotics. Differences in care based on socioeconomic factors (race, ethnicity, language, and insurance status) have not been characterized. We sought to compare differences in antibiotic choice and duration for different socioeconomic factors, and analyze changes after quality improvement (QI) efforts. Multidisciplinary QI team used multiple Plan- Do-Study-Act cycles and was successful in improving antibiotic duration for CAP and ABRS from a baseline of 13% to 61% (January …

Reducing Waste And Cost By Utilizing Tap Water For Laceration Irrigation In The Emergency Department: A Quality Improvement Approach, Alison L. Fowler, Rohan Akhouri, Josaih Galdean, Isabella Dunt, Christopher Kaberline, Viktoriya Stoycheva Mha, Rn, Cpn, Sarah Nienhaus, Leslie Hueschen

Posters

Purpose/Objective: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water decreases cost and waste without increasing rates of infection compared to sterile fluids. Currently, only 3.5% of lacerations closed in our ED are irrigated with tap water. This project aims to increase the percent age of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by March 2026 in a freestanding pediatric emergency department across two sites (ED 1, ED 2). Design/Methods: A multidisciplinary team (physicians, nurses, QI consultant, parent advisors) formed in November 2024. …

Nurse-Initiated Improvement For Documentation Of Penicillin Adverse Drug Reactions In Pediatric Urgent Care Clinics., Elizabeth Monsees, Diane Petrie, Rana El Feghaly, Sarah Suppes, Brian R. Lee, Megan Whitt, Amanda Nedved

Manuscripts, Articles, Book Chapters and Other Papers

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative., Allison Adam, Leslie Hueschen, Lina Patel, Christopher Kaberline, Ibad Siddiqi

Research Days

Background: Guidelines published by the National Heart, Lung and Blood Institute recommend that patients with sickle cell disease who present in acute pain crisis receive narcotic medication < 60 minutes from arrival. Multi-center studies indicate approximately 50% of institutions are adherent to this level 1a recommendation. From October 2022-October 2023, our institutional median time to narcotic was 61 minutes.

Objective: Our aim was to decrease the time to narcotic administration by 10% (61 min to 55 min) in patients with Sickle Cell Disease presenting to the emergency department for acute pain crisis while simultaneously decreasing disparities in our patient population by Oct 2024. Additionally, we sought to increase the percentage of patients within this population to receive their first narcotic in 60 min from 49% to 70%, by Oct 2024.

Methods: We …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Presentations

Background: Limiting antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it reduces unnecessary antibiotic exposure. In our emergency department (ED), >90% of respiratory infections are treated with first-line guideline-recommended antibiotics; however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). Institutional guidance recommends shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however only 13% of discharged ED patients receive the recommended duration. Objective: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenberg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Posters

Background: Antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it helps to limit unnecessary antibiotic exposure while continuing to provide appropriate care for infections. In our emergency department (ED), clinicians are using first-line guideline-recommended antibiotics as an appropriate choice for most patients (per our ASP report tracking), however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). National guidelines recommend shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however currently only 22% of patients discharged from our ED receive the recommended duration. Objective: …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative, Allison Adam, Lina Patel, Christopher Kaberline, Ibad Siddiqi, Leslie Hueschen

Posters

No abstract provided.

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Mitch Kinkor, Spencer Young, Colton Schwarz, Nicholas Clark, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout

Presentations

Introduction: Deaths related to drug overdose are at record highs, with over 110,000 recorded from May 2022-2023.1 75% of drug overdose deaths can be attributed to opioids.1 Pediatric opioid exposure is significant, with 406,000 American teens reporting illicit opioid use in 2022.2 Increased prescription opioids in circulation leads to increased opportunity for ingestion by children and adolescents. Current literature suggests most pediatric patients may only use one-two days’ worth of opioid doses prescribed for acute pain control, with the rest of prescribed doses going unused.3 From 2022-2023 in the Children’s Mercy Emergency Department (ED), 48% of children prescribed opioids for …

Pandemic Perspectives From Detained Youth During Covid-19: Bridging The Knowledge Gap For Future Safeguards., April Mcneill-Johnson, Zuri Hudson, Brittany Moore, Dumebi Okocha, Megha Ramaswamy, Kimberly Randell

Manuscripts, Articles, Book Chapters and Other Papers

Despite the worsening health disparities among youth in detention during the COVID-19 pandemic, there has been minimal exploration into the pandemic experiences of detained youth and opportunities for pandemic mitigation. This paper analyzes the perspectives of youth in detention on the pandemic, including the effect of the pandemic on their detention experience and their perceptions about COVID-19 vaccination. The study used purposive sampling to recruit 16 participants (aged 14-17 years) from two juvenile detention centers in the urban Midwest. We conducted semi-structured interviews and analyzed verbatim transcripts using a hybrid deductive-inductive approach and thematic analysis. Four themes emerged: 1) personal …

Paediatric Mass Casualty Response Through The Lens Of Functional Resonance Analytical Methodology- Lessons Learned., R J Mackinnon, D Slater, R Jenner, T Stenfors, Christopher S. Kennedy, K P Härenstam

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Mass Casualty Incidents are rare but can significantly stress healthcare systems. Functional Resonance Analytical Methodology (FRAM) is a systematic approach to model and explore how complex systems adapt to variations and to understand resilient properties in the face of perturbations. The aim of this study was to use FRAM to create a model of a paediatric trauma system during the initial response to the Manchester Arena Attack to provide resilience-based insights for the management of future Mass Casualty Incidents (MCI).

METHODS: Qualitative interviews in the immediate aftermath of a terrorist bombing, were followed up with further in-depth probing of …

Unilateral Facial Swelling In A Sickle Cell Patient., Rohan Akhouri, Alison L. Fowler, Colton Schwarz, Lina Patel

Manuscripts, Articles, Book Chapters and Other Papers

Acute soft head syndrome (ASHS) is a rare complication of sickle cell disease that often requires a high index of suspicion and is often a diagnosis of exclusion. We present the case of an 18-year-old male with sickle cell disease in the United States who developed acute soft head syndrome without known traumatic injury. The goal of this case presentation is to provide awareness and education regarding a rare complication of sickle cell disease and recommended management for the associated symptoms.

Delays To Antibiotics In The Emergency Department And Risk Of Mortality In Children With Sepsis., Roni D. Lane, Troy Richardson, Halden F. Scott, Raina M. Paul, Fran Balamuth, Matthew A. Eisenberg, Ruth Riggs, W Charles Huskins, Christopher M. Horvat, Grant E. Keeney, Leslie Hueschen, Justin M. Lockwood, Vishal Gunnala, Bryan P. Mckee, Nikhil Patankar, Venessa Lynn Pinto, Amanda M. Sebring, Matthew P. Sharron, Jennifer Treseler, Jennifer J. Wilkes, Jennifer K. Workman

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.

OBJECTIVE: To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from 51 US children's hospitals in the Improving Pediatric Sepsis Outcomes collaborative. Participants included patients aged 29 days to less than 18 years with sepsis recognized within 1 hour …

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

Life Threatening Anemia And Acidosis Secondary To Systemic Loxoscelism In A Pediatric Patient, Rohan Akhouri, Vincent J. Calleo, Leslie Hueschen

Posters

Introduction Rashes are common in pediatric patients and most resolve without significant patient illness. In rare cases, they can represent life-threatening disease entities. History is crucial to determine a rash’s etiology, and barriers like developmental delay and language can complicate accurate diagnosis. We present a case of hemodynamic instability and hemolysis without known envenomation, which was diagnosed as systemic loxoscelism. Case Description A 10-year-old male with developmental delay presented with decreased activity and reduced oral intake for 4 days. An interpreter was used due to a language barrier. Initial vital signs were T 36.6°C, HR=120, RR=20, BP=117/66, and SpO2 96%. …

Contraceptive Counseling For Adolescents In The Emergency Department: A Novel Curriculum For Nurse Practitioners And Physician Assistants., Laurel S. Gabler, Michelle Shankar, Tara Ketterer, Jennifer Molnar, Amber Adams, Jungwon Min, Elizabeth Miller, Romina Barral, Aletha Akers, Melissa K. Miller, Cynthia Mollen

Manuscripts, Articles, Book Chapters and Other Papers

Many adolescents use the emergency department (ED) as their primary source of health care. As a result, the ED serves as a unique opportunity to reach adolescents. Although many adolescent visits to the ED are related to reproductive health, ED providers report barriers to providing this care, including lack of training. Nurse practitioners (NPs) and physician assistants (PAs) serve a vital role in the provision of consistent care to adolescents in the ED. The purpose of this study was to create a curriculum to train NPs and PAs at two pediatric institutions to provide patient-centered contraceptive counseling to adolescents in …

Common Misperceptions Of Child Abuse In Toddler Femur Fractures, Olivia Pruss, Jonathan Warren, Vincent Staggs, Grace Tideman, Collin Erickson, William L. Hennrikus, Richard M. Schwend

Research Days

Background: Current AAOS guidelines recommend that all children younger than thirty-six months with a femur fracture be evaluated for child abuse. However, the chance for abuse in walking-age children is highly unlikely at less than 20%.

Objectives/Goal: The purpose of this study is to identify how a patient’s age and femur fracture morphology impact the likelihood that providers assess a fracture as non-accidental and their decision to pursue further investigation of possible child abuse.

Methods/Design: This was a questionnaire study completed by clinicians from multiple specialties. There were 5 subgroup populations (6, 12, 18, 24, 35 months old) combined with …

“There’S A Difference In Practice When You Have To Make The Decision”: Autonomy In Pediatric Emergency Medicine Fellowship, Katherine Dunne, Vivek Dubey, Sarkan Toy, Camryn Martinez, Kelsey Gavin, Christopher S. Kennedy

Research Days

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objectives/Goal: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Methods/Design: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program. A trained interviewer conducted the interviews over an electronic interview platform. Audio …

Pediatric Educational Outreach To A Community Based Emergency Department: Clinical Management Of The Febrile Infant, Jess Parker, Frances Turcotte Benedict, Emily Hillman, Ryan C. Jacobsen, Ashley K. Sherman, Arjun Sarin

Research Days

Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.

Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.

Methods/Design: …

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Parental Teach Back In The Ed Setting For Non-English Speaking Families, Rohan Akhouri

Presentations

90 million Americans have low health literacy1.in Missouri 35% of adults have prose literacy at or below basic skill level2. Literacy, more specifically health literacy, is a modifiable social determinant of health that has a large impact on patient care and outcome. Poor health literacy in adults is associated with a higher number of ED visits and worse health outcomes3,4. Teach back is a method used in multiple pediatric and adult settings, shown to improve patient outcomes and comfort with discharge instructions5. There is limited data regarding teach back in non-English speaking patients and its efficacy with this group of …

Outpatient Emergency Preparedness, Mary Haywood

Presentations

It is commonly believed that medical emergencies do not present to general pediatric offices. However, it has been estimated that 0.9-42 emergencies per office site/year occur. The most common presentations are respiratory in nature. However, children can also present with dehydration, seizure, psychiatric or behavioral complaints. Despite this, most offices are not prepared to handle these presentations for various reasons. Multiple studies have showed that preparedness in inpatient settings is improved with education, implementation, or protocols and deliberate practice with mock codes. However, there have been few studies in the outpatient setting. One study utilized simulation as a tool to …

Ultrasound Guided Peripheral Iv Access Curriculum For The Pediatric Emergency Department: A Pilot Study., Samuel Dillman, Frances Turcotte Benedict, Christopher S. Kennedy

Posters

Ultrasound Guided Peripheral IV Access Curriculum for the Pediatric Emergency Department: a pilot study. Background: Up to 50% of children have difficult venous access. Studies in the Pediatric Emergency department (PED) have shown that ultrasound guided peripheral IV (USGPIV) access has decreased IV access time and ED length of stay.  Barriers for use include lack of training and comfort with the procedure. Objectives/Goal: Our objectives are to pilot and evaluate USGPIV training for Pediatric Emergency Medicine (PEM) physicians and nurses.  Methods/Design: The course included a 4-hour, hands-on session with US IV training using a blue phantom task trainer in conjunction …

Patient Attitudes, Perceptions, Knowledge, And Beliefs Regarding Immigration Status In The Healthcare Setting, Anik Patel

Presentations

No abstract provided.

Simulation-Based System Analysis: Testing Preparedness For Extracorporeal Membrane Oxygenation Cannulation In Pediatric Covid-19 Patients., Alyssa Stoner, Robert Schremmer, Mikaela A. Miller, Kari L. Davidson, Rachael L. Pedigo, Jamie S. Parson, Christopher S. Kennedy, Eugenia K. Pallotto, Jenna Miller

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Coronavirus Disease-2019 presents risk to both patients and medical teams. Staff-intensive, complex procedures such as extracorporeal membrane oxygenation (ECMO) or extracorporeal cardiopulmonary resuscitation (eCPR) may increase chances of exposure and spread. This investigation aimed to rapidly deploy an in situ Simulation-based Clinical Systems Testing (SbCST) framework to identify Latent Safety Threats (LSTs) related to ECMO/eCPR initiation during a pandemic.

Methods: The adapted SbCST framework tested systems related to ECMO/eCPR initiation in the Neonatal and Pediatric Intensive Care Units. Systems were evaluated in six domains (Resources, Processes/Systems, Facilities, Clinical Performance, Infection Control, and Communication). We conducted three high-fidelity simulations with …

Initiative To Increase The Rate Of Emergency Department Physician Preprocedure Time-Out Documentation., Arjun Sarin, Nikita Sharma, Shobhit Jain

Manuscripts, Articles, Book Chapters and Other Papers

The preprocedure time-out is an important safety measure to verify patient identity and accuracy of a planned procedure. The time-out is an institutional and Joint Commission requirement. However, physicians in our emergency departments (EDs) document it inconsistently. We aimed to improve physician preprocedure time-out documentation for deep sedation (ketamine and/or propofol) from 75% to 90%, and separately for cutaneous abscess incision and drainage (I&D) from 94% to 98% by June 2020.

Methods: We analyzed 1 year of baseline data and weekly electronic medical record (EMR) reports from November 2019 through June 2020. Our outcome measures were the rate of physician …

Improving Skin And Soft Tissue Antibiotic Duration Concordance With National Guidelines In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian Lee, Rana El Feghaly

Posters

Introduction: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. Children with SSTIs often receive >7 days of antibiotics, although current guidelines recommend 5-7 days for most diagnoses. At CMH urgent care clinics (UCCs), only 58% patients received the recommended 5-7 days of antibiotics. We aimed to increase the percentage of patients receiving 5-7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021. Methods: We formed a multidisciplinary team in April 2020. A provider survey assessed factors influencing prescribing habits. …

A Novel Approach To Explore Safety-I And Safety-Ii Perspectives In In Situ Simulations-The Structured What If Functional Resonance Analysis Methodology., Ralph James Mackinnon, Karin Pukk-Härenstam, Christopher S. Kennedy, Erik Hollnagel, David Slater

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: With ever increasingly complex healthcare settings, technology enhanced simulation (TES) is well positioned to explore all perspectives to enhance patient safety and patient outcomes. Analysis from a Safety-II stance requires identification of human adjustments in daily work that are key to maintaining safety. The aim of this paper is to describe an approach to explore the consequences of human variability from a Safety-II perspective and describe the added value of this to TES.

METHODS: The reader is guided through a novel application of functional resonance analysis methodology (FRAM), a method to analyse how a system or activity is affected …

A Multicenter Evaluation Of Viral Bloodstream Detections In Children Presenting To The Emergency Department With Suspected Systemic Infection., Christina A. Rostad, Neena Kanwar, Jumi Yi, Claudia R. Morris, Jennifer Dien Bard, Amy Leber, James Dunn, Kimberle C. Chapin, Anne J. Blaschke, Judy A. Daly, Leslie Hueschen, Matthew Jones, Elizabeth Ott, Jeffrey Bastar, Kevin M. Bourzac, Rangaraj Selvarangan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections.

METHODS: We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted.

RESULTS: Of the 1114 subjects enrolled, …

Using Standardized Scripting To Improve Antibiotic Stewardship In A National Pediatric Urgent Care Collaborative, Amanda Nedved, Melody Fung, Cindy Liu, Rana Hamdy, Amanda Montalbano

Posters

Background: A study using administrative data reported urgent care providers as having the highest rates of inappropriate antibiotic use for upper respiratory illnesses. In a national survey, pediatric urgent care providers reported family expectations as a primary driver for prescribing inappropriate antibiotics. Standardized scripting has been effective at reducing unnecessary antibiotics while increasing family satisfaction.


Objective: To reduce inappropriate prescribing for upper respiratory infections (acute otitis media (AOM), otitis media with effusion (OME), and pharyngitis) in pediatric urgent cares by 20% by December 1, 2020 through use of standardized scripting in Year 2 of a national pediatric urgent care quality …