Quality Improvement Initiatives in Pediatric Emergency Care in Low-Resource Settings: Addressing Patient Safety and Outcomes.

Abstract

Background: Pediatric emergency care (PEC) in low-resource settings faces systemic challenges, including inadequate infrastructure, workforce shortages, and supply chain inefficiencies, which contribute to preventable morbidity and mortality. Quality improvement (QI) initiatives offer a structured framework to address these challenges, enhance patient safety, and improve clinical outcomes.

Methods: A narrative review was conducted using literature identified from PubMed and Google Scholar, supplemented by reports and guidance documents from the World Health Organization and nongovernmental organizations. Search terms included combinations of "pediatric emergency care," "quality improvement," "patient safety," "low-resource settings," "LMICs," "triage," "task shifting," "telemedicine," "digital health," and "community health workers." Eligible sources included primary studies, reviews, implementation reports, and policy documents addressing QI interventions, implementation barriers, facilitators, or outcomes relevant to PEC in low-resource settings.

Results: Included studies reported improvements in triage reliability, time to treatment, guideline adherence, patient-flow organization, workforce capacity, and data availability. Several triage- and ETAT-based interventions reported reductions in pediatric mortality or improved time-sensitive care processes, whereas digital health interventions improved triage completion, referral monitoring, and real-time decision support. Key enablers included local adaptation, staff training, audit and feedback, interdisciplinary collaboration, community engagement, and sustainable governance structures.

Conclusion: Strengthening QI initiatives is essential to achieving global health goals and ensuring equitable healthcare access for children in resource-limited settings. Sustainable, evidence-based interventions are critical for building resilient PEC systems and optimizing workflows.