Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media.

OBJECTIVES: Acute otitis media (AOM) is the most common reason for pediatric antibiotic prescriptions. The 2013 American Academy of Pediatrics' AOM guidelines recommend observation for nonsevere AOM. Our aim was to increase the percentage safety-net antibiotic prescription (SNAP) offered to patients 6 months of age or older diagnosed with AOM in 2 pediatric emergency departments (EDs) from a baseline of 0.5% to 15% in 20 months. METHODS: This is a quality improvement study at a quaternary pediatric medical center with 2 locations, both with EDs. A random chart review revealed that 27.5% of patients diagnosed with AOM in the ED would qualify for a SNAP, but only 0.5% were offered it. Quality improvement interventions were designed to improve safety-net antibiotic prescribing. Both EDs conducted multiple interventions, including algorithm development, provider education, and electronic medical record aids. The primary outcome measure was the percentage of patients offered a SNAP for AOM. RESULTS: A total of 8226 children 6 months of age or older were diagnosed with AOM in our 2 EDs during the 20-month intervention period. The percentage offered a SNAP increased at both EDs. One ED had a single shift in the mean to 7.9%, whereas the other had 2 shifts in the mean, an initial shift to 5.1% and a second to 7.3%. Providers consistently used the algorithm and electronic medical record aids. CONCLUSIONS: Safety-net antibiotic prescriptions in conjunction with parent education was effective in reducing the use of immediate antibiotic prescriptions in children with AOM in 2 pediatric EDs. Offering a SNAP can reduce unnecessary use of antibiotics, which in turn may decrease antibiotic-related adverse events and antibiotic resistance.

Laryngeal penetration during deglutition in normal subjects of various ages.

This study examined the frequency of penetration of liquid, paste, and masticated materials into the airway during videofluoroscopic studies of normal swallow in 98 normal subjects who were from 20 to 94 years of age. The purposes of the study were to define frequency and level of penetration using the penetration-aspiration scale as a result of age, bolus volume, viscosity, and gender, and to describe the body's sensorimotor response to the penetration based on audible coughs or throat clearing on the audio channel of each videotaped fluoroscopic study. Frequencies of penetration were defined in relation to bolus volume, age, gender, and bolus viscosity from swallows of 1, 3, 5, and 10 ml and cup-drinking of thin liquids; 3 ml of pudding; (1/4) of a Lorna Doone cookie; and a bite of an apple. Results showed that penetrations were significantly more frequent after age 50 and thick viscosities penetrated only in subjects age 50 and over. For persons under 50, 7.4% of swallows exhibited penetration, while for people age 50 and over, 16.8% of swallows showed penetration. Significantly more penetration occurred on larger liquid boluses. There was no relationship between gender and frequency of penetration. None of the subjects that penetrated showed a sensorimotor response to the penetration, which may relate to the relatively shallow depth of the penetration.