G418(P) The factors driving overdiagnosis of chest sepsis in children

Abstract

Aims As part of a quality improvement project, a baseline audit was undertaken in our Paediatric Department, which supported the hypothesis that children presenting with signs and symptoms of lower respiratory tract infection (LRTI) are over investigated and over treated with intravenous (IV) antibiotics. Before implementing a change of practice to prevent unnecessary investigations, notably Chest X-Rays (CXRs) and blood tests and reduce unnecessary antibiotic use, it is important to understand the factors driving overdiagnosis. We plan to undertake mixed quantitative-qualitative analysis to complete the planning stage of our PDSA cycle. Method We are now conducting a study, involving doctors in Paediatric departments across Kent. Using triangulation, we are collecting data using the following methods: Questionnaires to assess antibiotic prescribing practices for LRTI and adherence to local and national guidelines Semi–structured interviews to explore barriers and facilitators in adopting current guidelines and preventing overdiagnosis Focus groups including staff from multiple departments, including Paediatrics, Accident and Emergency, Microbiology and Pharmacy to consider factors driving overdiagnosis and over management Data will be analysed using Framework analysis to identify common themes. Results The key results from our baseline audit collected data from 156 children, stratified into sepsis risk as per NICE guidelines, were: 64% of patients with low oxygen saturations had co–existing wheeze 66% of patients were treated with IV antibiotics Only 9.8% of patients were treated with oral Amoxicillin as per BTS guidelines 88% had a CXR. Half were reported as normal, of which 71% were treated with IV antibiotics 78% of patients had blood tests including a CRP, which is not recommended to be routinely measured. We will also present the thematic analysis from our qualitative study at the conference. Conclusion This quantitative-qualitative data will allow us to understand the facilitators and barriers for the use of relevant guidelines by doctors working within Paediatric departments. Identifying and exploring the underlying factors driving overdiagnosis will enable us to introduce effective and workable measures to change practice prior to the next step in our quality improvement project.