An intervention that included educating providers and families on guidelines for group A Streptococcus, or GAS, testing reduced the use of rapid streptococcal tests, or RSTs, by more than half among children aged younger than 3 years presenting to an urban ED, according to researchers.
“Streptococcal pharyngitis is common in the pediatric population; however, in patients aged younger than 3 years, GAS is a rare cause of sore throat, and sequelae — such as acute rheumatic fever — are rare,” Tania Ahluwalia, MD, FAAP, assistant professor of pediatrics and emergency medicine at the George Washington University School of Medicine and Health Sciences, and colleagues wrote. “Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics.”
In October 2016, the researchers led interventions to reduce GAS testing in children aged younger than 3 years at in the ED at Children’s Mercy Kansas City, an urban, tertiary pediatric ED. The interventions included education for providers, nurses, residents and families; weekly visual updates on the number of RSTs used in children aged younger than 3 years through a daily management system; and a real-time alert reminding providers when RST use was appropriate through the ED’s electronic medical record system.
According to Ahluwalia and colleagues, the average monthly number of RSTs ordered decreased by 52% for children aged younger than 3 years in 10 months following the interventions. When RSTs were ordered during the study, 62% were ordered by nurse practitioners for children aged 25 to 36 months (66%).
The researchers noted that only one family reported grievances during the study, and no complications occurred because of the initiative. The reduction in RST use in this age group was sustained 8 months after the study.
“The success of this project was largely due to an interdisciplinary approach and an interest in practice improvement,” Ahluwalia and colleagues wrote. “The collaboration among physicians, NPs and nurses, in addition to the partnership between pediatric emergency medicine and pediatric infectious disease subspecialists, was a valuable asset. Through educational support and teamwork, we were able to build trust to engage our colleagues in this project.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.