- Design
- Single-centre quality improvement project with Plan-Do-Study-Act cycles
- Population
- Children discharged from a paediatric emergency department with community-acquired pneumonia or acute bacterial rhinosinusitis
- Primary outcome
- Percentage prescribed a guideline-recommended antibiotic duration
- Effect
- 13.1% to 64.8%; no change in 14-day return visits
A children's hospital emergency department aimed to raise the share of children discharged with pneumonia or acute bacterial sinusitis who received a guideline-recommended duration, which is 3 to 5 days for uncomplicated community-acquired pneumonia and 5 to 7 days for sinusitis, from 13% to 70%.
The team used clinical pathways, electronic record updates, prescriber education and feedback, and resources such as QR codes and a quick-discharge order set. The proportion with a recommended duration rose from 13.1% to 64.8% across three shifts between August 2023 and November 2024. Pneumonia drove most of the change, though sinusitis improved similarly. Return visits with the same diagnosis within 14 days did not change.
It is a single-centre improvement project without a control group, so it shows that the change is feasible rather than that it is safe in every setting. It also depends on guidelines that distinguish uncomplicated disease, and clinical judgement stays essential.
- Check your unit's usual pneumonia course against the 3 to 5 day guidance for uncomplicated disease
- Write the planned duration and stop date on the prescription
- Track return visits as a balancing measure when shortening courses
- Use local pathways and order sets so the shorter default is the easy default
- Complicated or severe disease needs individual decisions
Why it matters
Guideline updates change nothing unless prescribing systems change with them.
Don't overread it
A single-centre improvement report cannot prove the shorter courses are safe, and it applies only to uncomplicated disease.
The statistics, in plain English
A quality-improvement run chart shows a shift in the centre line, not a controlled comparison, so changes in case mix or coding could contribute. The absence of a rise in return visits is reassuring but does not exclude small harms.
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