ArticleBMJ quality & safety2014
Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.
Article in BMJ quality & safety, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Early oral versus prolonged intravenous antimicrobial treatment in children with bone and joint infections: a systematic review and meta-analysis.European journal of pediatrics · 2026Pooled it
- The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review.BMC health services research · 2020Pooled it
- The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review.PloS one · 2017Pooled it
- Appropriate Antibiotic Duration in Pediatric Bone and Joint Infection: A Systematic Review.Journal of the Pediatric Orthopaedic Society of North America · 2023Article
- Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients.Children (Basel, Switzerland) · 2022Article
- Big Data-Enabled Solutions Framework to Overcoming the Barriers to Circular Economy Initiatives in Healthcare Sector.International journal of environmental research and public health · 2021Article
- Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen.Hand (New York, N.Y.) · 2021Article
- Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach.BMJ open quality · 2021Article
- Opportunities for Stewardship in the Transition From Intravenous to Enteral Antibiotics in Hospitalized Pediatric Patients.Journal of hospital medicine · 2021Article
- Diagnosis and management of acute osteoarticular infections in children.Paediatrics & child health · 2018Review
- A Narrative Synthesis of the Components of and Evidence for Patient- and Family-Centered Care.Clinical pediatrics · 2016Article
- Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
backgroundSubstantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy.
objectiveFor patients with acute osteomyelitis admitted to the hospital medicine service, we aimed to increase the proportion of cases discharged on oral antibiotics to at least 70%.
methodsThe setting for our observational time series study was a large academic children's hospital. The model for improvement and plan-do-study-act cycles were used to test, refine and implement interventions identified through our key driver diagram. Our multifaceted intervention included a shared decision-making tool, an order set in our electronic health record, and education to faculty and trainees. We also included an identify and mitigate intervention to target providers caring for children with osteomyelitis in near-real time and reinforce the evidence-based recommendations. Data were analysed on an annotated g-chart of osteomyelitis cases between patients discharged on intravenous antibiotics. Structured chart review was used to identify treatment failures as well as length of stay and hospital charges in preintervention and postintervention groups.
resultsThe osteomyelitis cases between patients discharged on intravenous antibiotics increased from a median of 0 preintervention to a maximum of 9 cases following our identify and mitigate intervention. The direction and magnitude of successive improvements observed satisfied criteria for special cause variation. Improvement has been sustained for 1 year. Treatment failure and complications were uncommon in preintervention and postintervention phases. No significant differences in length of stay or charges were detected.
conclusionsEven for uncommon conditions, rapid and sustained evidence adoption is possible using quality improvement methods.
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