journal
https://read.qxmd.com/read/38344691/a-quality-improvement-initiative-to-transform-seasonal-immunization-processes-using-learning-from-the-coronavirus-2019-pandemic
#1
JOURNAL ARTICLE
Eric D Robinette, Pamela M Nelly, Laurie J Engler, Michael T Bigham
BACKGROUND: Surge demands for annual influenza vaccines challenge healthcare systems. Mass immunizations differ from the traditional care model. The coronavirus 2019 (COVID-19) pandemic challenged current care models with amplified demand and infection risks while challenging the organization to create new and improve existing processes. METHODS: Using the Model for Improvement, the team set out to (1) safely meet a surge in vaccination demand and (2) adopt pandemic-driven innovations into routine immunization practice...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38344690/improving-anticoagulation-care-for-pediatric-oncology-patients-a-quality-improvement-initiative
#2
JOURNAL ARTICLE
Vilmarie Rodriguez, Brockton S Mitchell, Joseph Stanek, Katherine Vasko, Jean Giver, Kay Monda, Joan Canini, Amy A Dunn, Riten Kumar
BACKGROUND: Cancer is associated with increased venous thromboembolism in children. Risk factors for venous thromboembolism in this cohort include using central venous catheters, mass effect from underlying malignancy, chemotherapy, and surgery. Anticoagulation management in this cohort is challenging, given recurrent episodes of thrombocytopenia, the need for invasive procedures, and coagulopathy. A quality improvement (QI) initiative was developed to improve hematology consultation services and provide documentation of an individualized anticoagulation care plan for this high-risk cohort...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38322297/implementation-of-an-anterior-mediastinal-mass-pathway-to-improve-time-to-biopsy-and-multidisciplinary-communication
#3
JOURNAL ARTICLE
Rachel E Gahagen, William C Gaylord, Meghan D Drayton Jackson, Anne E McCallister, Riad Lutfi, Jennifer A Belsky
BACKGROUND: Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38322296/impact-of-a-clinical-decision-support-alert-on-informed-consent-documentation-in-the-neonatal-intensive-care-unit
#4
JOURNAL ARTICLE
Emily Sangillo, Neena Jube-Desai, Dina El-Metwally, Colleen Hughes Driscoll
BACKGROUND: Informed consent is necessary to preserve patient autonomy and shared decision-making, yet compliant consent documentation is suboptimal in the intensive care unit (ICU). We aimed to increase compliance with bundled consent documentation, which provides consent for a predefined set of common procedures in the neonatal ICU from 0% to 50% over 1 year. METHODS: We used the Plan-Do-Study-Act model for quality improvement. Interventions included education and performance awareness, delineation of the preferred consenting process, consent form revision, overlay tool creation, and clinical decision support (CDS) alert use within the electronic health record...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38322295/antimicrobial-stewardship-and-improved-antibiotic-utilization-in-the-pediatric-cardiac-intensive-care-unit
#5
JOURNAL ARTICLE
Margot M Hillyer, Preeti Jaggi, Nikhil K Chanani, Alfred J Fernandez, Hania Zaki, Michael P Fundora
BACKGROUND: We developed a multidisciplinary antimicrobial stewardship team to optimize antimicrobial use within the Pediatric Cardiac Intensive Care Unit. A quality improvement initiative was conducted to decrease unnecessary broad-spectrum antibiotic use by 20%, with sustained change over 12 months. METHODS: We conducted this quality improvement initiative within a quaternary care center. PDSA cycles focused on antibiotic overuse, provider education, and practice standardization...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38322294/impact-of-a-bronchiolitis-clinical-pathway-on-management-decisions-by-preferred-language
#6
JOURNAL ARTICLE
Robert H Rosen, Michael C Monuteaux, Anne M Stack, Kenneth A Michelson, Andrew M Fine
BACKGROUND: Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care. METHODS: We included all emergency department encounters for patients aged 1-12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012-10/31/2020...
2024: Pediatric Quality & Safety
https://read.qxmd.com/read/38089833/a-quality-improvement-project-to-improve-the-utilization-of-an-intraoperative-rapid-response-system
#7
JOURNAL ARTICLE
Asheen Rama, Daniel Qian, Ty Forbes, Ellen Wang, Lynda Knight, Marc Berg, Thomas J Caruso
INTRODUCTION: Rapid response teams (RRTs) improve morbidity by reducing the incidence of cardiac arrests. Although providers commonly activate RRTs on acute care wards, they are infrequently used perioperatively. At our institution, two intraoperative calls for help exist: staff assists (SAs) and code blues (CBs). The SA functions analogously to an RRT, and the CB indicates cardiopulmonary arrest. Given the success of RRTs, this project aimed to increase the use of the SA system. Our primary goal was to increase the ratio of SA to CB alerts by 50% within 6 months...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089832/sustainability-standards-in-pediatric-anesthesia-quality-initiative-to-reduce-costly-environmentally-harmful-volatile-anesthetics
#8
JOURNAL ARTICLE
Andrew T Waberski, Sophie R Pestieau, Caroll Vazquez-Colon, Jessica Cronin, Barbara H Braffett
BACKGROUND: The emission and entrapment of greenhouse gases (GHG) inside the atmosphere is one of the leading causes of global warming. Commonly administered anesthetics have global warming potential up to 2,000 times greater than carbon dioxide. This Quality Improvement (QI) initiative aimed to develop a set of sustainability standards to reduce volatile anesthetic GHG emissions and costs at a children's hospital. METHODS: In January 2020, the QI project team implemented education sessions for clinical staff on the environmental impact of volatile anesthetics, bedside clinical reminders, resource guides on sustainable anesthesia practices, preset low-flow gas levels on anesthesia machines, relocated and reduced the number of available vaporizers, and implemented policies to standardize clinical practice...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089831/improving-pediatric-ovarian-torsion-evaluation-in-the-pediatric-emergency-department-a-quality-improvement-initiative
#9
JOURNAL ARTICLE
Brian L Park, Sara Fenstermacher, A Luana Stanescu, Lori Rutman, Lauren Kinneman, Patrick Solari
BACKGROUND: Transabdominal pelvic ultrasound (TPUS) is the diagnostic test of choice for the evaluation of ovarian torsion, a time-sensitive surgical emergency. A full bladder is required to visualize the ovaries. Bladder filling is a time-consuming process leading to delays to TPUS, poor visualization of ovaries requiring repeat studies, and prolonged emergency department length of stay (ED LOS). The primary objective was to decrease the time to TPUS by standardizing the bladder filling process...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089830/promoting-a-sleep-friendly-environment-by-minimizing-overnight-room-entries
#10
JOURNAL ARTICLE
Lauren M McDaniel, Nilesh Seshadri, Elizabeth A Harkins, Megan Keydash, Alice Pan, Laura M Sterni, Shawn L Ralston
INTRODUCTION: Despite its importance in illness recovery, the sleep of hospitalized children is frequently interrupted. This quality improvement intervention aimed to reduce overnight room entries by minimizing unnecessary interventions. METHODS: This study occurred at a university-affiliated children's hospital on the hospital medicine services from March 26, 2021, to April 14, 2022. The intervention included order set changes and the implementation of a rounding checklist designed to address factors most closely associated with sleep disruption and overnight room entries...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089829/multidisciplinary-initiative-to-increase-guideline-concordant-antibiotic-prescription-at-discharge-for-hospitalized-children-with-uncomplicated-community-acquired-pneumonia
#11
JOURNAL ARTICLE
Alexandra B Yonts, Laura B O'Neill, Matthew A Magyar, Michael J Bozzella
BACKGROUND: Clinical practice guidelines recommend using narrow-spectrum antibiotics to treat uncomplicated pneumonia in children. This quality improvement (QI) project aimed to evaluate if QI methods could improve guideline-concordant antibiotic prescribing at hospital discharge for children with uncomplicated pneumonia. METHODS: For this single-center QI project, we implemented QI interventions in serial plan-do-study-act cycles, focusing on the key drivers targeting general pediatric inpatient resident teams...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089828/reducing-the-time-to-action-on-bilirubin-results-overnight-in-a-newborn-nursery
#12
JOURNAL ARTICLE
Andrew M Beverstock, Lily Rubin, Meredith Akerman, Estela Noyola
INTRODUCTION: Infants commonly require phototherapy in the nursery to prevent kernicterus, but it can interfere with parent-infant bonding. Minimizing unnecessary phototherapy is important. We noticed frequent delays in initiating and discontinuing phototherapy at our hospital. Our primary aim was to start or stop phototherapy within 3 hours of the intended blood draw time for more than 80% of patients by August 2022. Our secondary aims were to have the bilirubin result available within two hours of the intended draw time and for the result to be actioned upon within 1 hour of becoming available...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089827/establishing-a-quality-improvement-program-for-pediatric-in-hospital-cardiac-arrest
#13
JOURNAL ARTICLE
Anya J Freedman, Erik C Madsen, Lia Lowrie
BACKGROUND: Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures. METHODS: We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38058473/decreasing-blood-culture-collection-in-hospitalized-patients-with-cap-ssti-and-uti
#14
JOURNAL ARTICLE
Monica D Combs, Danica B Liberman, Vivian Lee
BACKGROUND: Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months. METHODS: Quality improvement initiative at a children's hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38058472/increasing-covid-19-immunization-rates-through-a-vaccination-program-for-hospitalized-children
#15
JOURNAL ARTICLE
Victoria Mattick, Katelyn Cappotelli Nevin, Anne Fallon, Stephanie Northwood Darrow, Suzanne Ramazani, Travis Dick, Tina Sosa
INTRODUCTION: Inpatient coronavirus disease 2019 (COVID-19) vaccination initiatives offer a novel strategy to eliminate barriers to care, provide access to interprofessional teams, and decrease COVID-19 morbidity and mortality. Our inpatient vaccination initiative aimed to triple the baseline rate of eligible hospitalized children vaccinated against COVID-19 from 0.95% to 2.85% from December 2021 to June 2022. METHODS: We implemented a COVID-19 vaccination program for pediatric inpatients eligible to receive a dose based on age, current guidelines, and prior doses received...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38058471/decreasing-icu-and-hospital-length-of-stay-through-a-standardized-respiratory-therapist-driven-electronic-clinical-care-pathway-for-status-asthmaticus
#16
JOURNAL ARTICLE
Merrick Lopez, Michele Wilson, Ekua Cobbina, Danny Kaufman, Julie Fluitt, Michele Grainger, Robert Ruiz, Gulixian Abudukadier, Michael Tiras, Bronwyn Carlson, Jeane Spaid, Kim Falsone, Invest Cocjin, Anthony Moretti, Chad Vercio, Cynthia Tinsley, Harsha K Chandnani, Carlos Samayoa, Carissa Cianci, James Pappas, Nancy Y Chang
INTRODUCTION: Status asthmaticus (SA) is a cause of many pediatric hospitalizations. This study sought to evaluate how a standardized asthma care pathway (ACP) in the electronic medical record impacted the length of stay (LOS). METHODS: An interdisciplinary team internally validated a standardized respiratory score for patients admitted with SA to a 25-bed pediatric intensive care unit (PICU) at a tertiary children's hospital. The respiratory score determined weaning schedules for albuterol and steroid therapies...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38058470/improving-asthma-action-plan-completion-rates-across-five-divisions-in-an-academic-children-s-hospital
#17
JOURNAL ARTICLE
Maria G Alfieri, Katie Catalano, Tregony Simoneau, Linda Haynes, Patricia Glidden, Sachin N Baxi, Ramy Yim, Benjamin Ethier, Faye F Holder-Niles, Kendall McCarty, Frinny Polanco Walters, Eli Sprecher, Amy Starmer, Jonathan M Gaffin, Jeffrey Durney, Elizabeth Klements, Brittany Esty
INTRODUCTION: Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021. METHODS: We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/37818204/reducing-overutilization-of-high-flow-nasal-cannula-in-children-with-bronchiolitis
#18
JOURNAL ARTICLE
Diana Jo, Nisha Gupta, David Bastawrous, Hayley Busch, Asha Neptune, Amy Weis, Courtney Port
BACKGROUND: Bronchiolitis is a leading cause of pediatric hospitalizations. A high-flow nasal cannula (HFNC) does not significantly improve clinical outcomes and is associated with increased costs and intensive care unit (ICU) utilization. Despite this, hospitals continue to overuse HFNC in children with bronchiolitis. We aimed to reduce HFNC initiation in children hospitalized with bronchiolitis by 20 percentage points within 6 months. METHODS: This study included patients aged 1 month to 2 years diagnosed with bronchiolitis, excluding patients with prematurity less than 32 weeks or preexisting cardiopulmonary, genetic, congenital, or neuromuscular abnormalities...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/37818203/a-improving-birth-dose-hepatitis-b-vaccination-in-a-tertiary-level-iv-neonatal-intensive-care-unit
#19
JOURNAL ARTICLE
Indirapriya Avulakunta, Palanikumar Balasundaram, Alma Rechnitzer, Toshiba Morgan-Joseph, Suhas Nafday
BACKGROUND: Perinatal hepatitis B is a global public health concern. To reduce perinatal hepatitis B and its complications, the Hepatitis B vaccine (HBV) is recommended by the New York State Department of Health and Advisory Committee on Immunization Practices within 24 hours of life for infants born with a birth weight ≥2000 g. Infants admitted to the neonatal intensive care unit (NICU) weighing over 2000 g missed their birth dose HBV frequently, which prompted the implementation of a quality improvement initiative to increase birth dose HBV immunization in a level IV NICU in New York...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/37818202/closing-the-fluid-gap-improving-isotonic-maintenance-intravenous-fluid-use-in-a-community-hospital-network
#20
JOURNAL ARTICLE
Shraddha Mittal, Sheila Knerr, Julianne Prasto, Jessica Hunt, Carolyn Mattern, Tsae Chang, Ronald Marchese, Morgan Jessee, Lauren Marlowe, Josh Haupt
INTRODUCTION: The American Academy of Pediatrics recommends using isotonic intravenous fluids (IVF) for maintenance needs to decrease the risk of hyponatremia. We conducted a quality improvement project to increase the use of isotonic maintenance IVF in pediatric patients admitted to three sites in a community hospital network to >85% within 12 months. METHODS: We used improvement methodology to identify causes of continued hypotonic fluid use, which involved provider behavior and systems factors...
2023: Pediatric Quality & Safety
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