Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations by AAP

Written by Hina Zahid Published On 2021-11-08T09:00:15+05:30 | Updated On 8 Nov 2021 9:00 AM IST

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations by AAP

American Academy of Pediatrics has released 5 new Recommendations to Improve Value in Pediatric Hospital Medicine under Choosing Wisely campaign.

The health care system faces ongoing challenges due to low-value care. Building on the first pediatric hospital medicine contribution to the American Board of Internal Medicine Foundation Choosing Wisely Campaign, a working group was convened to identify additional priorities for improving health care value for hospitalized children.

The study team comprised of nominees from national pediatric medical professional societies was convened, including pediatric hospitalists with expertise in clinical care, hospital leadership, and research.

Using a modified Delphi process, the team completed a series of structured ratings of feasibility and validity and facilitated group discussion. The sum of final mean validity and feasibility scores was used to identify the 5 highest priority recommendations.

The 5 highest-scoring recommendations had a focus on the following aspects of hospital care: (1) length of intravenous antibiotic therapy before transition to oral antibiotics, (2) length of stay for febrile infants evaluated for serious bacterial infection, (3) phototherapy for neonatal hyperbilirubinemia, (4) antibiotic therapy for community-acquired pneumonia, and (5) initiation of intravenous antibiotics in infants with maternal risk factors for sepsis.

The pediatric hospitalists can use this list to prioritize quality improvement and scholarly work focused on improving the value and quality of patient care for hospitalized children.

1. Do Not Prescribe Intravenous Antibiotics for Predetermined Durations for Patients Hospitalized With Infections Such as Pyelonephritis, Osteomyelitis, and Complicated Pneumonia: Consider Early Transition to Oral Antibiotics.

2. Do Not Continue Hospitalization in Well-Appearing Febrile Infants Once Results of Bacterial Cultures (ie, Blood, Cerebrospinal, and/or Urine) Have Been Confirmed Negative for 24 to 36 Hours if Adequate Outpatient Follow-up Can Be Ensured

3. Do Not Initiate Phototherapy in Term or Late Preterm Well-Appearing Infants With Neonatal Hyperbilirubinemia if Their Bilirubin Levels Are Below Levels at Which the AAP Guidelines Recommend Treatment

4. Do Not Use Broad-Spectrum Antibiotics, Such as Ceftriaxone, for Children Hospitalized With Uncomplicated Community-Acquired Pneumonia; Use Narrow-Spectrum Antibiotics, Such as Penicillin, Ampicillin, or Amoxicillin

5. Do Not Start Intravenous Antibiotic Therapy on Well-Appearing Newborn Infants With Isolated Risk Factors for Sepsis, Such as Maternal Chorioamnionitis, Prolonged Rupture of Membranes, or Untreated Group B Streptococcal Colonization; Use Clinical Tools, Such as an Evidence-Based Sepsis-Risk Calculator, to Guide Management

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Hina Zahid

Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751