Effect of clinical pathways on antibiotic prescriptions in an emergency department: Italian pediatric antimicrobial stewardship starts here

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Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia.

BACKGROUND: Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum. MATERIALS AND METHODS: The CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared length of hospital stay for inpatients and treatment failure for inpatients and outpatients. Chi-square and Fisher\u27s exact test were used to compare categorical variables and Wilcoxon rank sum test was used to compare quantitative outcomes. RESULTS: 120 pre- and 86 post-intervention clinic visits were identified with a diagnosis of CAP. In outpatients, we observed a decrease in broad-spectrum regimens (50% pre-CP vs. 26.8% post-CP, p = 0.02), in particular macrolides, and an increase in narrow-spectrum (amoxicillin) post-CP. Post-CP children received fewer antibiotic courses (median DOT from 10 pre-CP to 8 post-CP, p CONCLUSIONS: Introduction of a CP for CAP in a Pediatric Emergency Department led to reduction of broad-spectrum antibiotic prescriptions, of combination therapy and of duration of treatment both for outpatients and inpatients

Closing the Impact Gap

As a new generation of spaces, Policy Labs are putting in practice experimental thinking and coming up with out-of-the-box solutions that can induce positive change. Apart from their differences in mandate, methods and affiliation, Labs are going for open, bottom-up or citizen-led processes, characterized by intense idea brainstorming, problem reframing, early needs assessment, co-creation, prototyping and testing before large scale deployment. A number of Labs have popped up, from MindLab in Denmark, La 27eme Region in France or LabX in Portugal (just to name a few in Europe), and even at the heart of the European Commission (EU Policy Lab). Within the current panorama, Lab practitioners and the "converted" underline experimentation's added value in spurring innovation in policy-making. The most innovative ideas don't arise from closed settings, but instead in real-life contexts or hybrid spaces with freedom to collaborate with others and try out risky processes. But just how far Labs have gone in implementing this narrative? What are the most pressing gaps to address for the near future when looking for success and scalability?JRC.I.2-Foresight, Behavioural Insights and Design for Polic

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia - Fig 2

<p>a–b. Median DOT pre and post-implementation for outpatients and DOT over time for outpatients. c. Median LOT pre and post-implementation for outpatients. d. LOT over time for outpatients.</p

Characteristics of inpatient population.

<p>Characteristics of inpatient population.</p

Median amoxicillin dosage over time.

<p>Median amoxicillin dosage over time.</p

Characteristics of outpatients population.

<p>Characteristics of outpatients population.</p

Flowchart of children enrolled during the pre and post-intervention period.

<p>Flowchart of children enrolled during the pre and post-intervention period.</p

bsDOT/DOT for outpatients.

<p>bsDOT/DOT for outpatients.</p