journal
https://read.qxmd.com/read/38571734/qualitative-study-on-safe-and-effective-handover-information-during-a-rapid-response-team-encounter
#21
JOURNAL ARTICLE
Justin M Greenberg, Anita Schmidt, Todd P Chang, Alyssa Rake
INTRODUCTION: A rapid response team (RRT) evaluates and manages patients at risk of clinical deterioration. There is limited literature on the structure of the rapid response encounter from the floor to the intensive care unit team. We aimed to define this encounter and examine provider experiences to elucidate what information healthcare staff need to safely manage patients during an RRT evaluation. METHODS: This phenomenological qualitative study included 6 focus groups (3 in-person and 3 virtually) organized by provider type (nurses, residents, fellows, attendings), which took place until thematic saturation was reached...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38571733/pediatric-inpatient-leaders-views-changed-with-covid-19-a-call-to-re-engage-in-quality-improvement
#22
JOURNAL ARTICLE
Denise D Quigley, Mary Ellen Slaughter, Ron D Hays
No abstract text is available yet for this article.
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38571732/new-strategies-to-reduce-unnecessary-antibiotic-use-in-the-nicu-a-quality-improvement-initiative
#23
JOURNAL ARTICLE
Alfonso Pantoja, Scott Sveum, Sandra Frost, Amanda Duran, Jeanne Burks, Christi Schernecke, Michelle Feinberg
INTRODUCTION: Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. METHODS: Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38571731/improving-wait-times-for-children-with-caregivers-with-limited-english-proficiency-in-the-emergency-department
#24
JOURNAL ARTICLE
Gisella Valderrama, Gia M Badolato, Pedro Diaz, Deena Berkowitz
INTRODUCTION: In our pediatric emergency department (ED), children triaged as low acuity who presented with Spanish-speaking caregivers with limited English proficiency (SSLEP) experienced disparately longer wait times than similarly triaged children with English-proficient caretakers. Although inequities in ED care based on language preference exist, little is known about effective interventions to eliminate the disparity. This quality improvement study aimed to eliminate the disparity in wait times and share effective interventions...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38571730/utilizing-clinical-decision-support-in-the-treatment-of-urinary-tract-infection-across-a-large-pediatric-primary-care-network
#25
JOURNAL ARTICLE
David R Karas, Shankar Upadhyayula, April Love, Michael T Bigham
INTRODUCTION: Cystitis and pyelonephritis are common bacterial infections in infants and children, and initial treatment is usually empirical. Antimicrobial stewardship advocates using narrow-spectrum antibiotics with consideration for local resistance patterns. Narrow-spectrum antibiotic use is critical in addressing the global issue of bacterial antimicrobial resistance, associated with approximately 5 million annual deaths. METHODS: The antimicrobial stewardship committee developed a guideline for diagnosing and managing urinary tract infections and distributed it to all primary care providers...
2023: Pediatric Quality & Safety
https://read.qxmd.com/read/38089833/a-quality-improvement-project-to-improve-the-utilization-of-an-intraoperative-rapid-response-system
#26
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
#27
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
#28
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
#29
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
#30
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
#31
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
#32
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
#33
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
#34
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
#35
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
#36
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
#37
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
#38
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
#39
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
https://read.qxmd.com/read/37818201/identifying-children-in-foster-care-and-improving-foster-care-documentation-in-primary-care
#40
JOURNAL ARTICLE
Camille A Broussard, Julia M Kim, Brittany Hunter, LaToya Mobley, Maria Trent, Rebecca Seltzer
BACKGROUND: Children and youth in foster care (CYFC) are a population with special healthcare needs, and the American Academy of Pediatrics has healthcare standards to care for this population, but implementation challenges include identifying clinic patients in foster care (FC). Documentation of FC status in the Electronic Health Record (EHR) can support the identification of CYFC to tailor care delivery. Therefore, we aimed to improve the percentage of CYFC with problem list (PL) documentation of FC status from 20% to 60% within 12 months...
2023: Pediatric Quality & Safety
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