Effects of Clinical Pathway Implementation in Management of Pediatric Inpatients with Pneumonia: A Cross-Sectional Study in Indonesia

Abstract

Pneumonia is the leading cause of morbidity and mortality in children worldwide. Antibiotics are the mainstay treatment for bacterial pneumonia so their use should be clearly mentioned in the pneumonia clinical pathway (CP). This study aimed to evaluate the effectiveness of pneumonia CP in pediatrics. A cross-sectional observational study was conducted in a private hospital in Indonesia. The inclusion criteria were pediatric patients admitted with pneumonia in the period of January-December 2017 (pre-CP period) and January-December 2018 (post-CP) and receiving antibiotics. The effectiveness of CP was evaluated according to four parameters: length of stay, clinical outcomes, quality (Gyssens antibiogram) and quantity of antibiotics. A total of 121 eligible patients’ medical records were analyzed (60 before and 61 after CP implementation). Second and third generation cephalosporins (42.1%) predominated the use of antibiotics pre-CP period, whilst aminoglycosides (59.6%) constituted more than half of antibiotic use in post-CP group. More than half of the patients stayed in the hospital not more than 3 days pre-CP period vs 31.1% post-CP period. Nearly all patients had good clinical outcomes during hospitalization between both periods. The proportion of quality of antibiotics was less than 5% either before or after CP implementation. The quantity of antibiotics post-CP (408.42 defined daily dose/DDD per 100 patient days) was almost two times of pre-CP period (222.42 DDD per 100 patient days). In conclusion, implementation of CP could not achieve the targeted goals to reduce the length of hospitalization and improve the antibiotic use. No discernible difference was observed in clinical outcomes before and after CP implementation.