A quality improvement (QI) initiative implemented at five community hospitals was associated with increased prescribing of narrow-spectrum antibiotics for pediatric pneumonia, a team of researchers from Harvard Medical School reported yesterday in Pediatrics.

The initiative involved the creation of multidisciplinary teams at each hospital that were tasked with increasing narrow-spectrum antibiotic use (ampicillin or amoxicillin) from 60% to 80% in patients aged 3 months to 18 years presenting with a pneumonia diagnosis in the emergency department (ED).

After four collaborative meetings, the teams developed site-specific interventions that were implemented at 3-month intervals, including deployment of an evidence-based treatment guideline, educational sessions, and order-set modification. To evaluate the interventions, the teams collected monthly prescribing data for 1 year, compared those data with baseline data from the previous year, and added an additional year to assess the sustainability of the intervention.

The analysis included 1,641 patients—531 in the baseline period, 703 during the intervention phase, and 407 in the sustainment phase. The aggregated rate of narrow-spectrum antibiotic prescriptions for pediatric pneumonia rose from 60% during the baseline period to 78% during the intervention period, then rose to 92% during the sustainment phase. During the intervention period, narrow-spectrum antibiotic prescribing rates improved from 72% to 85% for pediatric physicians and from 53% to 70% for general emergency medicine providers, then climbed 93% and 91%, respectively, during the sustainment phase. No change in the 72-hour emergency department return rate was observed.

Our findings ... reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics.

The authors say improving use of narrow-spectrum antibiotics for pediatric pneumonia is particularly important in community hospitals, because they see 90% of pediatric emergency patients, and pneumonia is one of the most common diagnoses in pediatric emergency medicine.

"Our findings, in the setting of 5 pediatric EDs within community hospitals, reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics," they wrote.

New research from Spain and the United Kingdom shows patients who suffered heart attacks during the initial COVID-19 lockdowns can expect to live up to 2 years less than those who had heart attacks before the pandemic, likely because they were limited in accessing life-saving treatments quickly.

The findings are presented in the European Heart Journal - Quality of Care and Clinical Outcomes.

To assess the impact on healthcare costs and life expectancy, the authors created a model to compare outcomes from STEMIs (ST-elevation myocardial infractions) seen in patients during the first month of COVID-19 lockdowns with those who had a heart attack at the same time in the previous year.

They estimated that 77% of prepandemic STEMI patients in the United Kingdom were hospitalized during the prior month, compared with 44% during lockdown. The equivalent rates for Spain were 74% and 57%. Patients likely avoided going to a hospital during a STEMI because of fear of contracting a COVID-19 infection and because of limited health services.

Estimated 1.5 to 2 years of life lost

In total, UK STEMI patients were predicted to lose an average of 1.55 life-years and 1.17 QALYs (quality-adjusted life-years). In Spain the model predicted STEMI patients during the lockdown would survive 2.03 years less than pre-pandemic patients. Moreover, the delays in care were predicted to cost both countries more money in health services.

"The findings illustrate the repercussions of delayed or missed care," said lead study author William Wijns, PhD, of the University of Galway, Ireland, in a press release from the European Society of Cardiology, which publishes the journal. "Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come.

Health services need a list of lifesaving therapies that should always be delivered.

"Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay."