September 2019 HSC Section 1 Congenital and Pediatric Problems

International Journal of Pediatric Otorhinolaryngology 108 (2018) 163–167

L. Newton et al.

Financial disclosures

level to obtain these specimens. There may also be parental pressure for ENT to be the ones to obtain these cultures, as parents also may feel more comfortable with the specialist obtaining these specimens. The referral patterns from pediatric primary care providers to ENT are appropriate. Similarly, primary care and urgent care providers are following the 2013 AAP guidelines by not routinely ordering sinus CT, unless there is a concern of a complication of sinusitis. Just like anti- biotic stewardship programs, there has been a push to “ image carefully ” in all patients, particularly children. In our sample, providers seem familiar with the guidelines for when a patient with sinusitis should be imaged and are following these guidelines. Both within specialty areas and between the three specialties sam- pled, there is bene fi t for consistency in clinical management. Consistent diagnosis and management of rhinosinusitis will be easier for patients and families, as they know their child will be treated the same re- gardless of provider or location. Similar management strategies will also allow for consistent messaging from nursing and other support sta ff to families, decreasing potential confusion and dissatisfaction with treatment plans. The providers in this sample all work together on these patients in some form, and it would be bene fi cial for all of the providers to adopt similar practice guidelines to standardize diagnosis and man- agement of pediatric rhinosinusitis. The next steps in this quality im- provement project are to disseminate the results to all participants with the goal to educate all providers on the current 2013 AAP guidelines and to de fi ne practice across all settings, ultimately resulting in better coordination of care and overall quality of care. 5. Conclusion

None.

Con fl icts of interest

None.

References

[1] S.S. Smith, R.C. Kern, R.K. Chandra, et al., Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings, Otolaryngol. Head Neck Surg. 148 (2013) 852 – 859 . [2] R.P. Venekamp, M.M. Rovers, T.J. Verheij, Treatment of acute rhinosinusitis: dis- crepancy between guideline recommendations and clinical practice, Fam. Pract. 29 (2012) 706 – 712 . [3] A.L. Hersh, D.J. Shapiro, A.T. Pavia, et al., Antibiotic prescribing in ambulatory pediatrics in the United States, Pediatrics 128 (2011) 1053 – 1061 . [4] A.L. Sharp, M.H. Klau, D. Kerschner, et al., Low-value care for acute sinusitis en- counters: who's choosing wisely? Am. J. Manag. Care 21 (2015) 479 – 485 . [5] M.A. Pynnonen, S. Lynn, H.E. Kern, et al., Diagnosis and treatment of acute sinusitis in the primary care setting: a retrospective cohort, Laryngoscope 00 (2015) 1 – 7 . [6] J.S. Gerber, P.A. Prasad, A.G. Fiks, et al., E ff ect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians, J. Am. Med. Assoc. 309 (2013) 2345 – 2352 . [7] S.M. McNeely, Rhinosinusitis: an urgent care perspective, Am. J. Clinical Medicine 9 (2012) 98 – 101 . [8] E.M. Sarpong, G.E. Miller, Narrow-and broad-spectrum antibiotic use among US children, Health Serv. Res. 50 (2014) 830 – 846 . [9] S.E. Brietzke, J.J. Shin, S. Choi, et al., Clinical consensus statement: pediatric chronic rhinosinusitis, Otolaryngol. Head Neck Surg. 15 (2014) 542 – 553 . [10] E.R. Wald, K.E. Applegate, C. Bordley, et al., Clinical practice guidelines for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years, Pediatrics 132 (2013) 262 – 280 .

137