Evaluation of a Clinical Practice Algorithm for Pediatric Complicated Pneumonia: A Retrospective, Observational, Single-Center Study.

OBJECTIVE: The diagnostic evaluation, antibiotic treatment, and type and timing of surgical intervention for pediatric patients with complicated pneumonia is not standardized and may lead to increased length of stay, more radiation exposure, and higher cost. A multidisciplinary team at our institution developed a clinical practice algorithm for pediatric complicated pneumonia to align and optimize care. The aim of this study was to examine the effectiveness of this algorithm in improving overall patient care while minimizing changes in physician workload. STUDY DESIGN: A clinical practice algorithm for pediatric complicated pneumonia was created and implemented at our institution in February 2018 based on expert opinion and literature review, providing guidance on options for imaging, antibiotics, and interventions based on clinical characteristics. Retrospective data were collected for 31 months before and after implementation excluding a six-month transition period. RESULTS: Forty patients were identified (pre-protocol implementation=25, post-protocol implementation=15). There were no differences in age, race/ethnicity, and size of pleural effusion between groups. Following protocol implementation, the time to pediatric surgery consult, number of consulting services, ICU admission, number and types of radiologic studies, and readmission rates remained unchanged. Protocol implementation was associated with a significant decrease in the need for repeat procedures (32% vs. 0%, p=0.02). There was a trend toward decreased length of stay (10.0 vs. 9.0 days, p=0.31). CONCLUSIONS: Implementation of our institutional protocol did not increase utilized services and was associated with a decrease in the need for additional procedures after treatment failure. Larger prospective studies may help optimize the approach to complicated pneumonia.