- Design
- Single-centre quality-improvement study with Plan-Do-Study-Act cycles
- Population
- Children discharged from a US paediatric emergency department with pneumonia or bacterial sinusitis
- Primary outcome
- Percentage prescribed a guideline-recommended antibiotic duration
- Effect
- 13.1% to 64.8%; no change in 14-day return visits
National and international guidance now supports 3–5 days of antibiotics for uncomplicated community-acquired pneumonia in children and 5–7 days for acute bacterial sinusitis. In this US paediatric emergency department only 13% of children discharged with either diagnosis were getting those durations.
A multidisciplinary quality-improvement team introduced updated clinical pathways with QR-code access, changed electronic health record order sets including a quick-discharge set for pneumonia, educated prescribers and fed back their data. Over successive cycles from 2023 to 2024, the share on a recommended duration rose to 64.8%. Most of the gain was in pneumonia, the commoner diagnosis; sinusitis improved similarly. Return visits with the same diagnosis within 14 days did not change.
This is a single-centre before-and-after improvement study, not a trial of short courses themselves — that evidence already exists. Its value is practical: changing the default in the order set and making the pathway easy to reach moved prescribing far more than guidance alone. The same levers are available in most hospitals and clinics.
- Prescribe 3–5 days of antibiotics for uncomplicated community-acquired pneumonia in children.
- Prescribe 5–7 days for acute bacterial sinusitis.
- Set the default duration in electronic order sets to the recommended course.
- Give parents a clear stop date and safety-net advice.
- Audit your own prescribed durations against the recommended courses.
Why it matters
Guidance on short courses has existed for years; what moved practice here was changing the default, not the evidence.
Don't overread it
A single-centre before-and-after study cannot exclude other changes over time, though no rise in return visits is reassuring.
The statistics, in plain English
Quality-improvement studies track a centre line on a run chart; a shift means a sustained change rather than random variation. The balancing measure — return visits — checks that the gain did not cause harm.
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