Summer 2021
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Pediatric Academic Societies Pediatric Urgent Care Research
Antibiotic Stewardship, PUC Fellowships and Trauma Management
By Emily Montgomery MD FAAP
Director of Education for the Division of Urgent Care, Children’s Mercy Kansas City
Clinical Assistant Professor of Pediatrics, University of Missouri-Kansas City
Due to the COVID pandemic, this year’s Pediatric Academic Societies (PAS) annual meeting was held virtually, with Phase I (April 30-May 4) featuring scholarly sessions, platforms, plenaries and poster presentations, and Phase II (May 10-June 4) featuring workshops, special interest groups, clubs and more. Phase I ended with a robust representation of pediatric urgent care (PUC) research, with posters and platform presentations on antibiotic stewardship, PUC fellowship and PUC trauma care.
Antibiotic Stewardship
Ashley DeSchepper BS from the University of Missouri-Kansas City and Amanda Nedved MD, Donna Wyly RN MSN CPNP-AC PPCNP-BC and Rana El Feghaly MD MSCI from the University of Missouri-Kanas City and Children’s Mercy Kansas City presented an opportunity for antibiotic stewardship, as they found that antibiotic prescribing rates were high for patients with otitis media with effusion. A group of PUC providers from Children’s Mercy Kansas City, Amanda Nedved MD, Holly Austin MD, Donna Wyly RN MSN CPNP-AC PPCNP-BC, and Diana King RN MSN CPNP-PC, along with their infectious disease colleagues from the same institution found another opportunity for antibiotic stewardship efforts. One-third of children with SSTIs at Children’s Mercy urgent care centers received >7 days of antibiotics. These findings, shared via the e-poster Antibiotic Duration for Skin and Soft Tissue Infections in Pediatric Urgent Care Centers, illustrate the necessity of quality improvement projects for antibiotic duration.
On a related note, Barbara Amakye MD from Nationwide Children’s Hospital gave a platform presentation Using QI tools to Increase Short Duration Antibiotic Therapy for SSTIs in an Urgent Care Network. Their goal was to increase short duration of antibiotic therapy for SSTIs from 43% to 75% and sustain for six months. Their interventions through building and updating EHR Smart Sets and educating clinicians, staff and families increased short duration therapy from 43 to 85% without an increase in return visits.
The Society for Pediatric Urgent Care recognizes and continues to address antibiotic stewardship needs. The poster Using Standardized Scripting to Improve Antibiotic Stewardship in a National Pediatric Urgent Care Collaborative presented findings from SPUC’s collaborative efforts to reduce inappropriate antibiotic use. This poster was presented by Amanda Nedved MD and Amanda Montalbano MD MPH from UMKC and CMH, Cindy Liu MD MPH from George Washington University, and Rana Hamdy from Children’s National Hospital. This group found that the intervention of standardized scripting decreased inappropriate antibiotic prescribing by 20%. Rana Hamdy MD MPH MSCE presented this research in more detail during Implementing Antibiotic Stewardship in Telemedicine and Urgent Care Settings.
PUC Fellowship
A group from Children’s National and George Washington University School of Medicine and Health Sciences, Haroon Shaukat MD, Ioannis Koutroulis MD PhD MBA, Denna Berkowitz MD MPH and Emily Willner MD MEd, presented their work on pediatric urgent care fellowships in a pair of posters: The Emergence of Academic Pediatric Urgent Care Fellowships: Entrustable Professional Activities, and The Emergence of Academic Pediatric Urgent Care Fellowships: Goals and Objectives via a Modified Delphi Process. The first poster presents a set of proposed PUC-specific EPAs, and the second poster presents proposed goals and objectives for PUC fellowships, both developed by a modified Delphi process.
PUC Trauma Management
The poster Urgent Care Management of Traumatic Injuries from Paige Chardovayne, a medical student from Penn State, myself, and Dr. Robert Olympia from Penn State examined PUC management of traumatic injuries. This survey study of a convenience sample of pediatric urgent care members of SPUC found that PUC providers manage most traumatic injuries in line with national standards of care. Future educational efforts may focus on traumatic brain injury, as the survey found that providers may not recognize altered mental status as requiring transfer to a higher level of care. This contrasts with previous research on unnecessary transfer to the ED which has found that general UC transfer rates are high.
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