Pediatric quality & safety最新文献

{"title":"Synthesizing Interest-holder Perspectives and Evidence-based Potentially Better Practices to Improve High-risk Infant Follow-through Care Quality.","authors":"Lindsay Rosenfeld, Nisha Dalvie, Cindy Chwa, Jonathan S Litt","doi":"10.1097/pq9.0000000000000929","DOIUrl":"10.1097/pq9.0000000000000929","url":null,"abstract":"<p><strong>Introduction: </strong>Despite specialized high-risk infant follow-up (HRIF) being the standard of care for preterm and medically complex infants after hospital discharge, program participation remains low, and equity gaps persist. Little work has examined HRIF's perceived value, or lack thereof, for families, staff, and other key interest-holders. Our objective was to examine interest-holders' perspectives of the value of the HRIF program using qualitative methods to inform continuous quality improvement (CQI) work.</p><p><strong>Methods: </strong>Families (n = 6) and staff (n = 9) in a single, urban pediatric hospital HRIF program participated in semistructured interviews. National content experts (n = 4) did as well. All interviews explored barriers and facilitators to HRIF participation, patient experience, and program goals/operations using a grounded theory approach to thematic analysis. Finally, the resulting themes were compared to the domains of the Vermont Oxford Network's Potentially Better Practices (PBPs) for Follow-Through.</p><p><strong>Results: </strong>A majority (≥50%) of participants highlighted each theme. Staff and family themes included HRIF staff's care expertise for formerly preterm infants, the benefits of long-term monitoring, and the need for greater family engagement and action on social determinants of health. Families alone indicated a need for better support during transitions from the neonatal intensive care unit and HRIF. Most participants highlighted the program's multidisciplinary nature as important. Study themes were synergistic with PBP domains.</p><p><strong>Conclusions: </strong>Interviews with key interest-holders identified benefits of HRIF program participation while offering critical insights into opportunities for CQI initiatives. Given the alignment of evidence-based PBPs with reported themes, future research should explore the clinical application of PBPs in follow-through CQI work.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e929"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department.","authors":"Noreen Bux","doi":"10.1097/pq9.0000000000000919","DOIUrl":"10.1097/pq9.0000000000000919","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e919"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Patient Throughput Through Front-end Redesign and Alternate Care Space Implementation in a Pediatric Emergency Department: A Quality Improvement Initiative.","authors":"Cortney C Braund, Bernadette K Johnson, Shaela Moen, Sandra Spencer, Travis Justilian, Suzanne Sternberg, Kristin Vickrey, Matthew Cerchie, Candise Dunham, Nidhya Navanandan","doi":"10.1097/pq9.0000000000000923","DOIUrl":"10.1097/pq9.0000000000000923","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) crowding remains a persistent national challenge, contributing to delays in care, increased length of stay (LOS), and higher rates of patients leaving without being seen (LWBS). Front-end strategies improve throughput and reduce LWBS by enabling earlier assessment and disposition. Building on prior efforts, this quality improvement initiative aimed to enhance patient flow for low-acuity pediatric patients by leveraging alternative care spaces to reduce roomed-to-disposition time, LOS, and LWBS while preserving capacity for higher acuity care.</p><p><strong>Methods: </strong>This initiative occurred in a high-volume pediatric ED using a front-end, physician-driven \"Intake\" model. To improve efficiency and throughput, the team introduced an alternate care space. Additional interventions included role clarification, workflow standardization, and targeted education for physicians and staff to reduce roomed-to-disposition time for Intake patients by 10% within 4 months.</p><p><strong>Results: </strong>Roomed-to-disposition time for all Intake patients decreased by 15% (from 88 to 75 min), whereas a specific group of low-intervention patients experienced a 49% reduction. LOS for all Intake patients decreased by 30%, and by 48% for low-intervention patients (from 286 to 148 min). Additional improvements included a 49% reduction in LWBS and a 37% decrease in arrival-to-provider time.</p><p><strong>Conclusions: </strong>Our quality improvement initiative demonstrated that a thoughtful reorganization of existing ED Intake processes, without additional staffing or physical expansion, can meaningfully improve patient throughput, provider efficiency, and overall ED performance.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e923"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement and Quality Improvement.","authors":"Lloyd P Provost","doi":"10.1097/pq9.0000000000000886","DOIUrl":"10.1097/pq9.0000000000000886","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e886"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter Regarding \"Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department\".","authors":"Jonathan A Hermel, Yvette Wang, Jamie M Klapp, Amy Bryl, Martha Pannepacker, Elise Zimmerman","doi":"10.1097/pq9.0000000000000917","DOIUrl":"10.1097/pq9.0000000000000917","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e917"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Interpreter Use for Pediatric Cardiology Units: A Quality Improvement Initiative.","authors":"Dulce Maria E Ovalle Sanchez, Jennifer Gauntt, Ronna Porterfield, Robert J Gajarski","doi":"10.1097/pq9.0000000000000933","DOIUrl":"10.1097/pq9.0000000000000933","url":null,"abstract":"<p><strong>Introduction: </strong>Effective communication between healthcare teams, patients, and families is critical to achieving high-quality care. Despite US regulations requiring language services, interpreters remain underutilized, and there is no standardized approach to communication in hospital settings. This quality improvement project aimed to increase interpreter use for families who speak a language other than English (LOE) from 94 to 122 occurrences/100 LOE-patient-days, the average interpreter interaction time/patient/month from 10 to 13 minutes, and the average interpreter use percentage during emergencies from 29% to 44% by December 31, 2025, in the acute care cardiology and cardiothoracic settings.</p><p><strong>Methods: </strong>Baseline data from January 2022 to August 2024 were evaluated, and implemented interventions focused on 3 categories: increased interpreter accessibility, interpreter-use education, and the creation of translated documents. The number of interpreter occurrences and average interpreter minutes/patient/month, indexed to LOE-patient-days, were tracked monthly using statistical process control charts. A statistical process control p-chart was used to track the number of patients for whom an interpreter was used during emergencies as a function of total LOE patients who experienced an emergency with parents present.</p><p><strong>Results: </strong>Interpreter use increased from 94 to 212 occurrences/100 LOE-patient-days whereas the average interpreter minutes/patient/month increased from 10 to 23 minutes following the interventions. The percentage of interpreter use during emergencies increased from 29% to 91%. Process and balancing measures tracked intervention utilization and unintended consequences.</p><p><strong>Conclusions: </strong>Interventions that directly increased interpreter use helped standardize care for families who spoke an LOE, thereby enhancing healthcare communication, literacy, and family engagement.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e933"},"PeriodicalIF":1.2,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing Prescriber Errors in a Tertiary Care Pediatric Intensive Care Unit via QI Methodology.","authors":"Timothy Brandt, Dhara D Shah, Gina Cassel-Choudhury","doi":"10.1097/pq9.0000000000000909","DOIUrl":"10.1097/pq9.0000000000000909","url":null,"abstract":"<p><strong>Introduction: </strong>Medication errors are a significant source of preventable adverse drug events for pediatric patients, particularly those with a complex chronic condition (CCC). In our pediatric intensive care unit (PICU), medication errors often occurred during admission or as medication regimens were adjusted throughout hospitalization. Our primary aim was to reduce the rate of reported prescriber medication errors per 1,000 medication orders by 40% between August 2022 and June 2024.</p><p><strong>Methods: </strong>Key drivers contributing to prescriber medication errors included the lack of a standardized medication reconciliation process, high-risk medications unintentionally expiring, and the difficulty of reconciling the home medication list for patients with a CCC. Five plan-do-study-act interventions were completed. A retrospective chart review was used for all baseline data. The primary outcome was the rate of reported monthly prescriber medication errors per 1,000 medication orders placed. This project took place in a 26-bed PICU within an urban, tertiary care children's hospital.</p><p><strong>Results: </strong>The rate of reported prescriber medication errors remained stable throughout the intervention period without evidence of special cause variation. However, admission medication reconciliation errors among children with CCCs decreased by a mean of 43% over time, with a downward centerline shift.</p><p><strong>Conclusions: </strong>A multidisciplinary quality improvement approach was associated with improvement in medication reconciliation processes for children with CCCs. Pharmacy-supported medication reconciliation and standardized workflows were associated with fewer admission medication reconciliation errors in this high-risk population.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e909"},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact on Health Disparities: Secondary Analysis of an Unplanned Extubation Quality Improvement Study.","authors":"Gayathri Sreenivasan, Parvathy Krishnan, Lance A Parton, Meenakshi Singh","doi":"10.1097/pq9.0000000000000922","DOIUrl":"10.1097/pq9.0000000000000922","url":null,"abstract":"<p><strong>Introduction: </strong>Quality improvement (QI) initiatives have reduced unplanned extubation (UE) rates in neonatal intensive care units, but few studies have examined the equity of these improvements. An explicit equity focus in QI can reveal disparities that may otherwise remain unrecognized. This secondary analysis of a previously published UE prevention QI initiative aimed to identify baseline disparities in UE rates and determine whether these disparities narrowed following the implementation of a standardized best-practice bundle (BPB).</p><p><strong>Methods: </strong>We reviewed 6 months of preintervention medical record data and stratified UE rates by race/ethnicity, preferred primary language, and socioeconomic status (insurance as a proxy). Using the Model for Improvement, the QI team implemented the BPB components sequentially and uniformly across the neonatal intensive care unit. Data collection continued throughout implementation. Statistical process control (U) charts were used to examine baseline disparities and assess changes over time.</p><p><strong>Results: </strong>At baseline, non-Hispanic Black infants, patients from English-speaking families, and Medicaid-insured patients had higher UE rates. Following the implementation of the BPB, UE rates decreased across all subgroups. Control charts showed special-cause variation beginning in December 2022. Differences in UE rates across racial/ethnic, language, and socioeconomic groups narrowed.</p><p><strong>Conclusions: </strong>UE rates were higher among racial minority and lower socioeconomic status populations at baseline. A standardized QI approach was associated with lower UE rates across all subgroups and reduced baseline disparities.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e922"},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Improvement Initiative: Implementation of a Unified Pediatric Asthma Pathway Reduces Critical Care Requirements.","authors":"Jocelyn A Livezey, Jessica Witkowski, Kendra Grether-Jones, Moonjoo Han, Michelle Linenberger, Stephanie Mateev, Kirsten McCullough, Heather McKnight, JoAnne Natale, Kriston Reneau, Brian J Smith, Lisa Tsang, Leah Tzimenatos, Michelle Y Hamline","doi":"10.1097/pq9.0000000000000915","DOIUrl":"10.1097/pq9.0000000000000915","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma management is a leading cause of pediatric hospitalizations, contributing to a significant economic burden and critical care resource use. Standardized asthma care pathways have been shown to improve care delivery and resource allocation. We aimed to determine whether a unified asthma clinical pathway that integrates care across multiple care settings would reduce pediatric intensive care unit (PICU) and hospital length of stay (LOS) in an academic tertiary-care hospital.</p><p><strong>Methods: </strong>We designed a unified asthma pathway to integrate care across the emergency department, PICU, and ward. Quality improvement interventions included the unified clinical pathway, an electronic medical record order set, a standardized discharge checklist, and clinician education. The study team evaluated patients admitted with a primary diagnosis of asthma between 24 months and 18 years of age in the \"baseline\" group (May 2023-March 2024) or \"intervention\" group (April 2024-July 2025). The primary outcome was LOS, and the secondary outcomes were assessed using statistical process control charts. Wards-to-PICU transfers, 30-day hospital readmissions, and 7-day emergency department revisits served as balancing measures.</p><p><strong>Results: </strong>Overall hospital and PICU LOS remained consistent between the baseline (n = 168) and intervention periods (n = 217). After pathway implementation, there was a significant reduction in the number of patients requiring PICU-level care (31% versus 13%) and a reduction in the average time on continuous albuterol (7.4-3.2 h). Balancing measures remained unchanged between groups.</p><p><strong>Conclusions: </strong>Implementation of the unified asthma pathway in an academic tertiary-care hospital reduced the number of patients requiring PICU-level care and the time on continuous albuterol without an increase in adverse events.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e915"},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustaining Quality Improvement to Increase Adverse Childhood Experience Questionnaire Response Rates and Proposal of Plan-do-study-act-assess Cycle.","authors":"Sarah A Commaroto, Kelly Campbell, Madison Tyle, Melissa Chow, Shainal Gandhi, Monica Khadka, Marilyn Torres, Emily Coughlin, Vinita Kiluk","doi":"10.1097/pq9.0000000000000920","DOIUrl":"10.1097/pq9.0000000000000920","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e920"},"PeriodicalIF":1.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}