ArticleAnnals of emergency medicine2025
Clinical Pathway Revision Increases Amoxicillin Monotherapy and 5-Day Durations of Therapy for Pediatric Community-Acquired Pneumonia in the Emergency Department and Urgent Care: A Quality Improvement Initiative.
Article in Annals of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Designing Reliable Care Through Clinical Pathways: A Human Factors Framework.Healthcare (Basel, Switzerland) · 2026Article
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Authors and funding
7 authors.
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Abstract
STUDY
objectiveThe American Academy of Pediatrics recommends 5-day amoxicillin monotherapy as first-line treatment for pediatric uncomplicated community-acquired pneumonia. We aimed to use local quality improvement interventions to increase first-line amoxicillin use, reduce azithromycin use, and increase 5-day therapy durations for uncomplicated community-acquired pneumonia.
methodsA quality improvement initiative took place at a pediatric hospital network, including 4 emergency departments (EDs) and 5 urgent care centers. Children discharged between July 2018 and July 2022 with a community-acquired pneumonia diagnosis and an antibiotic prescribed were included. A 2-part intervention was implemented: (1) an electronic health record order set that preselected 5-day antibiotic therapy (August 2020) and (2) a revised community-acquired pneumonia pathway newly integrated into the electronic health record (April 2021). Proportions of antibiotic encounters receiving amoxicillin, azithromycin, and antibiotic durations of 5 days or fewer were analyzed using statistical process control charts to identify special cause variation.
resultsOrder set implementation had no effect on pediatric community-acquired pneumonia prescribing. After pathway revision, amoxicillin prescribing increased from 60.6% to 70.9%, azithromycin prescribing decreased from 12.5% to 3.7%, and durations for 5 days or fewer increased from 2.0% to 66.1%.
conclusionA revised, electronic health record-integrated community-acquired pneumonia pathway was associated with improving already high adherence to guideline-recommended antibiotic choice and reducing antibiotic durations for pediatric community-acquired pneumonia in ED and urgent care settings. Local quality improvement efforts, when adapted to institutional workflows and culture, can effectively implement clinical pathways to support evidence-based prescribing for uncomplicated community-acquired pneumonia across diverse health care settings.
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