PC1214: Turning the Tide: Increasing Safety Net Antibiotic Prescriptions (SNAP) for Acute Otitis Media Treatment in Pediatric Urgent Care Centers

Purpose/Objectives: Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in pediatrics. Most AOM cases resolve without antibiotics. National guidelines recommend offering a safety net antibiotic prescription (SNAP) to a select group of patients with mild symptoms, to be filled if symptoms worsen or do not improve within 48-72 hours. This approach has been shown to decrease antibiotic exposure in eligible patients. However, clinicians continue to prescribe immediate antibiotics for most cases of AOM. In our review of all AOM patients diagnosed in three freestanding pediatric urgent care (PUC) clinics within our organization from October 2020 through September 2021, SNAP was only offered to 7.7% of eligible patients.

We aimed to increase the percentage of eligible patients diagnosed with AOM in our PUC clinics who are offered a SNAP from 7.7% to 40% within nine months.

Design/Methods: A multidisciplinary team including urgent care clinicians, an Infectious Diseases physician, and a data analyst, used quality improvement (QI) methodology to identify barriers to offering SNAP (Figure 1), and high-impact interventions. These included clinician education, standardized discharge instructions, electronic health record updates to improve documentation, and educational flyers for clinicians and families. Some clinicians received a monetary incentive for documenting SNAP eligibility; however, the incentive was not dependent on offering SNAP. We created monthly reports of encounters with patients ≥ 6 months old with a discharge diagnosis of AOM from three PUC clinics during the baseline period (October 2020 – September 2021) and study period (October 2021 – March 2022). Patients without history of chronic ear conditions were considered eligible for SNAP, as defined by national guidelines, if they had no or mild otalgia for < 48 hours, fever < 39oC, no otorrhea, and for children ≤ 24 months old, if they had only unilateral AOM. Our process measure was the percentage of AOM encounters in which SNAP eligibility was documented. Our outcome measure was the percentage of encounters during which SNAP was offered.

Results: We reviewed 12,502 encounters between October 2020 and March 2022. At baseline, clinicians documented SNAP eligibility in 5.5% of AOM encounters, and 7.7% of eligible patients were offered SNAP. By March 2022, clinicians increased documentation of SNAP eligibility to 58.9%. The percentage of eligible patients who were offered SNAPs increased to 40.7% (Figure 2). Although the percentage of patients who were offered and accepted SNAPs decreased from 73.9% to 56.5%, the total number of patients who accepted SNAPs increased from 39 to 126.

Conclusion/Discussion: Using QI methodology, we increased the percentage of eligible patients with AOM who were offered SNAP, reducing antibiotic exposure in a PUC setting. Efforts are ongoing to further improve this process.