Pediatric quality & safety最新文献

{"title":"Improving Diagnostic Quality of Anogenital Photodocumentation in Emergency Department Evaluations for Acute Child Sexual Assault.","authors":"Zachary E Miller, Sara J Digirolamo, Jennifer Molnar, Colleen E Bennett, Sabrina Darwiche, Brandon C Ku, Philip V Scribano","doi":"10.1097/pq9.0000000000000876","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000876","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department evaluations for acute child sexual assault include anogenital photodocumentation as a standard of care, which has implications for accurate clinical care and forensic significance. If photodocumentation quality is suboptimal from a diagnostic standpoint, this may lead to wasted care and resources and place needless burdens on patients and families. Our project aimed to improve the diagnostic quality of anogenital photodocumentation at 2 sites in a pediatric emergency department, increasing it from a baseline of 24% to 50% during a 9-month intervention period.</p><p><strong>Methods: </strong>We surveyed multiple clinical teams to determine drivers of diagnostic quality. Using the Model for Improvement, we implemented multiple interventions (clinical pathway revisions, visual guidance, direct provider feedback, and an improved light source option) in the care process for these patients and measured diagnostic quality using a definition adapted from a validated photograph-scoring system. We used statistical process control charts to track diagnostic quality.</p><p><strong>Results: </strong>We detected no special-cause variation in the outcome measure of improved diagnostic quality. We detected special-cause variation for the process measure of whether care teams obtained photodocumentation, which increased from 77% to 89%.</p><p><strong>Conclusions: </strong>Interventions to improve the diagnostic quality of anogenital photodocumentation did not result in improvement; however, there was improvement in the likelihood of care teams obtaining photodocumentation in acute sexual assault evaluations.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e876"},"PeriodicalIF":1.1,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635434","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":"Emergency Department Undertriage: Using Multidisciplinary Case Review to Drive Quality Improvement.","authors":"Nichole L McCollum, James M Chamberlain, Kelly Williams, Brandon Kappy, Tanika Jones, Lindsay Stein, Anthony Thomas, Amanda Alleyne, Deena D Berkowitz","doi":"10.1097/pq9.0000000000000878","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000878","url":null,"abstract":"<p><strong>Introduction: </strong>Triage determines the priority of evaluation. Undertriage, the underestimation of patients' acuity, poses a safety risk. Undertriaged patients in the pediatric emergency department (PED) experience longer times to intravenous placement, nebulization therapy, and disposition. We described a multidisciplinary, team-based case review process to decrease our rate of clinically important undertriage.</p><p><strong>Methods: </strong>We defined clinically important undertriage as patient visits with an Emergency Severity Index (ESI) triage score of 4 or 5 in which the patient required admission or received aerosolized medication, oxygen, or intravenous medication. Cases were identified by an electronic health record tool, and then, a sample of cases was randomly assigned for review. Nurse-provider dyads and a multidisciplinary team reviewed undertriage cases monthly to determine whether a different ESI level should have been assigned based on information available at triage. The primary outcome measure was the proportion of patients triaged as ESI 4 and 5 with clinically important undertriage. The balancing measure was overtriage, defined as patients triaged as ESI 3 requiring fewer than 2 resources.</p><p><strong>Results: </strong>A total of 543 visits identified by electronic health record query were reviewed from September 2023 to September 2024. Interventions resulted in a decrease in the rate of clinically important undertriage by 14%, resulting in a centerline shift.</p><p><strong>Conclusions: </strong>Clinically important undertriage serves as a valuable quality metric to improve triage processes within the PED. Multidisciplinary team-based interventions successfully decreased the undertriage rate in the PED.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e878"},"PeriodicalIF":1.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624920","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":"Improving Compliance With Safe Sleep Guidelines for Vulnerable Patients in a Community Safety Net Hospital Neonatal Intensive Care Unit.","authors":"Andrew Beverstock, Samantha Carlton, Hillary Lee, Thomas Lu, Kelsi Morgan, Ashlee Smith-Patel, Kelli Phillips, Joseph Hagan, Pablo Lohmann, Caraciolo Fernandes, Lisa Owens, Daniela Dinu","doi":"10.1097/pq9.0000000000000877","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000877","url":null,"abstract":"<p><strong>Introduction: </strong>Modeling safe sleep in the neonatal intensive care unit (NICU) increases the likelihood that parents will follow these practices after discharge. Many NICU infants are put to sleep unsafely, and unsafe sleep practices are the leading cause of nonnatural death among children locally. We created safe sleep standards for infants older than 32 weeks based on national guidelines: infants should be placed supine in a flat, empty crib and should never be swaddled loosely. We aimed to increase the weekly percentage compliance with safe sleep recommendations from a baseline of 58% (0.58 compliant) to 85% (0.85 compliant) by March 2025 in our level II and III NICUs based on random crib audits.</p><p><strong>Methods: </strong>In plan-do-study-act cycle 1, we educated residents and fellows about safe sleep practices in the NICU and changed our daily electronic medical record smart phrase to integrate safe sleep readiness. In PSDA cycle 2, we educated nurses about safe sleep and implemented nonrecline cribs. In plan-do-study-act cycle 3, we implemented bedside signs for each crib with reminders of our standards.</p><p><strong>Results: </strong>We successfully achieved our aim. Our mean compliance increased from 58% (0.58 compliant) at baseline to 91% (0.91 compliant) postintervention.</p><p><strong>Conclusions: </strong>Our project successfully improved compliance with safe sleep practices of the current nursing staff: our interventions moving forward will focus on embedding safe sleep practices into our NICU culture so that our changes are sustainable. Our ongoing interventions will be promoting \"nursing safe sleep champions,\" continuing to perform regular audits, and further implementing the use of sleep sacks instead of loose swaddles.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e877"},"PeriodicalIF":1.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624866","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":"Massachusetts Multisite Quality Improvement to Address Family Engagement in Level 2-3 Neonatal Intensive Care Units.","authors":"Margaret G Parker, Aviel Peaceman, Zuzanna Kubicka, Molly Fraust-Wylie, Nicole Lomerson, Justin Goldstein, Alyssa Marshall, Rachana Singh, Didem Ayturk, Erika G Cordova-Ramos","doi":"10.1097/pq9.0000000000000875","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000875","url":null,"abstract":"<p><strong>Introduction: </strong>Family engagement is a cornerstone of neonatal care. Few multisite quality improvement efforts using robust quality metrics focused on family engagement have occurred in the neonatal intensive care unit (NICU) setting. We aimed to increase the following measures of NICU family engagement by 20% or more of baseline within 2 years without disparities by maternal race/ethnicity or preferred language in Massachusetts NICUs: (1) multidisciplinary family meetings within 7 days; (2) social work consultations within 7 days; (3) assessment of families' unmet basic needs; (4) any mother's milk at discharge; (5) more than 50% participation in skin-to-skin care; and (6) training in discharge skills 48 hours or more before discharge.</p><p><strong>Methods: </strong>We used an Institute for Healthcare Improvement Breakthrough Series framework of multisite quality improvement, which included collaborative, large-scale meetings and training interspersed with local quality work. From January 2021 to December 2022, we collected data on 459 infants admitted for 14 days or more. We examined family engagement measure rates quarterly using run charts and compared overall rates by maternal race/ethnicity and preferred language using χ² tests. We performed pilot data collection on parent-reported measures.</p><p><strong>Results: </strong>Forty-seven plan-do-study-act cycles were conducted. We found increases in training on discharge skills (from 57% to 90%) and in the assessment of unmet basic needs (from 39% to 96%). Many drivers occurred more often among infants with non-White and non-English-speaking mothers.</p><p><strong>Conclusions: </strong>Massachusetts NICUs implemented multiple interventions to increase family engagement. Our development and testing of chart-abstracted and family-reported measures of family engagement across a wide variety of topics may be generalizable to other NICUs working in this area.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e875"},"PeriodicalIF":1.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624947","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":"Implementing Participation-level Goals to Improve Patient-Centeredness in Pediatric Rehabilitation.","authors":"Kelly Tanner, Jamie B Boster, Erin Gates, Alex Rospert, Shelley Coleman Casto, Sara O'Rourke, Jessica Gillespie, Rachel Bican","doi":"10.1097/pq9.0000000000000874","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000874","url":null,"abstract":"<p><strong>Introduction: </strong>The global goal of pediatric rehabilitation services is to increase the ability of children to participate in meaningful life activities. Services that do not include a participation-centered goal are unlikely to achieve this impact. In this study, a participation component was operationally defined as a reference to a person or place outside the therapy context, regardless of the practice setting or discipline. The aim was to increase the use of participation-level goals among patients seen across all departments in the Division of Clinical Therapies from 50% to 80% by December 31, 2022, and sustain this level for 6 months.</p><p><strong>Methods: </strong>We implemented Plan-Do-Study-Act cycles in accordance with the Model for Improvement endorsed by the Institute for Healthcare Improvement. We tailored interventions for 6 participating departments. Strategies included audit and feedback, targeted communication with teams, and the use of champions. Then, we sampled charts across departments. We analyzed data using a statistical process control chart with a baseline mean of 32.5% and a target of 80%.</p><p><strong>Results: </strong>The goal of 80% of charts containing a rehabilitation goal with a participation-level component was achieved after 24 months of interventions, reaching a new centerline of 82% and sustaining this level for 6 months.</p><p><strong>Conclusions: </strong>We implemented patient goals with a participation component across multiple rehabilitation departments within a large division of a major pediatric hospital, using quality improvement methodology. Departments benefited from general strategies (eg, reminders) and tailored interventions (eg, targeted communication) to achieve and maintain 80% compliance.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e874"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610889","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":"Reexamining Feeding Tube Safety in Pediatrics: A Safety Event Rooted in Device Design and Instruction Gaps.","authors":"Christopher J Demas, RoseAnn Dubke, Rebecca A Pehovic, Katherine E Bates","doi":"10.1097/pq9.0000000000000873","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000873","url":null,"abstract":"<p><strong>Introduction: </strong>Nasogastric (NG) tubes are commonly used in hospitalized infants and children to provide nutrition and medications. Although clinical protocols emphasize the importance of confirming placement and tube patency, they pay less attention to the mechanical limits of NG tubes and the risks of fracture or rupture. Inconsistent guidance regarding tube care may contribute to preventable harm, particularly in the techniques used to clear obstructions.</p><p><strong>Methods: </strong>We presented a case of a newborn who experienced irreversible harm following an NG tube fracture or rupture. This event prompted a multidisciplinary review and simulated evaluation of NG tube performance using varying syringe sizes to mirror common bedside practices.</p><p><strong>Results: </strong>Simulation testing demonstrated that small-volume syringes, particularly 1-3 mL, can generate pressures high enough to balloon or rupture NG tubes. In contrast, larger syringes (≥30 mL) did not cause damage, even under maximum force. At the time of these events, manufacturer instructions did not provide pediatric-specific guidance regarding syringe selection, and local protocols additionally lacked specific recommendations. The size of the syringe selected may have contributed to tube fracture, esophageal rupture, and subsequent patient death.</p><p><strong>Conclusions: </strong>This case highlighted a safety gap in pediatric NG tube care, stemming from device performance and inconsistent instructional guidance. Improved alignment between manufacturer instructions and clinical resources, as well as pediatric-specific safety protocols, is essential to prevent similar events.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e873"},"PeriodicalIF":1.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313324","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":"Reducing Laboratory Testing and Blood Draws in the Newborn Nursery to Increase High-value Care.","authors":"Lauren Z Foster, Liza Natale, Jenna Lukaszewicz, Maria Kleynerman, Julie Colameco, Jane Weckesser, Cristin Ortale, Elizabeth Haines","doi":"10.1097/pq9.0000000000000866","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000866","url":null,"abstract":"<p><strong>Introduction: </strong>Newborn infants undergo multiple blood tests before hospital discharge, some of which are unnecessary due to outdated hospital policies and provider variability. Reducing nonevidence-based laboratory testing can improve healthcare value, and clustering of blood sampling can reduce pain for newborns.</p><p><strong>Methods: </strong>This quality improvement project aimed to reduce the weekly number of laboratory tests and blood draws per patient-day for newborns by 10% within 8 months. A multidisciplinary team developed and addressed key drivers with Plan-Do-Study-Act cycles. Interventions included high-value care education, implementation of the 2022 American Academy of Pediatrics hyperbilirubinemia clinical guidelines, and modification of the blood type and screen testing workflow. The balancing measures were to maintain the average length of stay less than 48 hours and a 7-day readmission rate less than 1.5%. Data were collected using electronic health record reports and analyzed with statistical process control charts.</p><p><strong>Results: </strong>The study included 7,749 newborn nursery patients during a 22-month period. Laboratory tests per patient-day decreased from 1.41 to 0.84 after implementation of the new American Academy of Pediatrics hyperbilirubinemia guidelines, and further decreased to 0.53 with changes to the type and screen workflow. The number of blood draws per patient-day decreased from 0.47 to 0.20 with implementation of the updated hyperbilirubinemia guidelines. Average length of stay increased from 47.4 to 50.7 hours, associated with unrelated hospital changes. Readmission rates were stable.</p><p><strong>Conclusions: </strong>This quality improvement project exceeded the study goal, achieving a 62% reduction in laboratory tests and a 57% reduction in blood draws performed on newborns, thereby increasing value and decreasing pain without adverse effects.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e866"},"PeriodicalIF":1.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291741","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":"Reducing Unplanned Pediatric Extubations by Modifying Analgosedative Infusions.","authors":"John S Giuliano, Shannon Hassmann, Christine Curello, Aziez Ahmed, Oliver Karam, Alexa Berez, Lauren Edwards, Sarah B Kandil","doi":"10.1097/pq9.0000000000000868","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000868","url":null,"abstract":"<p><strong>Introduction: </strong>To decrease unplanned extubations (UEs), we aimed to reduce the use of fentanyl as the first-line opioid infusion for intubated patients in our combined pediatric and pediatric cardiac intensive care units by 10% within 1 year.</p><p><strong>Methods: </strong>The quality improvement initiative began in July 2023 and focused on drivers such as education, sedation standardization, and data transparency. Education was provided to physicians, advanced practice practitioners, and nursing staff, with the creation of a sedative/analgesic infusion order set to standardize the ordering of morphine and hydromorphone for intubated patients admitted to the pediatric and pediatric cardiac intensive care units. We tracked data using statistical process control charts, shared at faculty meetings, and displayed on the unit to increase awareness.</p><p><strong>Results: </strong>During the baseline period (July 2022-June 2023), fentanyl was the first-line opioid infusion 45.5% of the time with 9 UEs. After implementation, first-line fentanyl infusions decreased to 18.1%. UEs also decreased to 5 from July 2023 to December 2024. The UE rate decreased from 1.03 per 100 ventilator days to 0.10 per 100 ventilator days during 1.5 years. We also observed improvements in the number of days between UE events, with a trend toward longer intervals.</p><p><strong>Conclusions: </strong>Maintaining pediatric endotracheal tubes is multifactorial, with analgosedative infusions playing a prominent role. Adjusting the medication choice of first-line opioid infusions may be associated with a decrease in UE events.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e868"},"PeriodicalIF":1.1,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291864","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":"Improving Single Maintenance and Reliever Therapy for Patients Admitted for Asthma Exacerbation.","authors":"Katherine A Pumphrey, Jessica K Hart, Joseph J Zorc, Michelle B Dunn, Colleen M Shannon, Levon H Utidjian, Chén C Kenyon","doi":"10.1097/pq9.0000000000000867","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000867","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, single maintenance and reliever therapy (SMART) became guideline-recommended care for school-age children in the United States with poorly controlled, persistent asthma. Pediatric inpatient providers are well positioned to prescribe SMART, as they often care for patients with poorly controlled asthma. Our interdisciplinary team aimed to increase the proportion of SMART prescriptions at discharge for eligible pediatric patients admitted for asthma exacerbation from 17% to 40% by September 2023, consistent across strata of payor type, race, and Child Opportunity Index (COI).</p><p><strong>Methods: </strong>Four primary drivers of SMART prescription at discharge were identified: familiarity, prescriber culture, decision support, and logistics. Interventions targeting these drivers, including education and clinical decision support, were implemented during 10 Plan-Do-Study-Act cycles. This quality improvement project included patients who were prescribed an inhaled controller medication on admission and had 2 or more hospitalizations and/or emergency room visits for asthma exacerbation requiring systemic corticosteroids within 12 months. The outcome measure was SMART prescription at discharge, stratified by payor type, race, and COI.</p><p><strong>Results: </strong>Between January 2021 and December 2023, 312 hospital encounters involving 215 unique patients occurred. SMART prescription at discharge increased from 17% at baseline to 38% and was sustained for 19 months. Similar increases in SMART prescriptions at discharge were observed among Black patients, those with government-sponsored health insurance, and those with very low COI.</p><p><strong>Conclusions: </strong>Using quality improvement methodology, SMART prescriptions increased at discharge for pediatric patients admitted for asthma exacerbation, including in demographic strata where disparities are often observed.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e867"},"PeriodicalIF":1.1,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286521","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":"Adapting <i>PICU UP!</i> to Enhance Early Mobility in a Level IV Neonatal Intensive Care Unit: A Quality Improvement Project.","authors":"Brooke A Krbec, Denise Casey, Benjamin G Ethier, Anthony Dekermanji, Megan Dakhlian, Mary-Jeanne Manning, Sapna R Kudchadkar, Kristen T Leeman","doi":"10.1097/pq9.0000000000000862","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000862","url":null,"abstract":"<p><strong>Introduction: </strong>Patient acuity in the neonatal intensive care unit can lead to inadequate focus on developmental care. Structured approaches to promote early mobility can improve outcomes.</p><p><strong>Methods: </strong>Our team adapted and implemented the <i>PICU Up!</i> program for the neonatal population and established an early mobility strategy for surgical infants born at 34 weeks' gestation or later. Our specific aim was to increase the percentage of eligible surgical patients who receive physical therapy (PT) and occupational therapy (OT) consultations from 25% and 22% to greater than 75% within 24 months. Additional measures included time to consult placement, length of stay, pressure injury rate, unplanned extubations, and fractures. The interventions tested a quality improvement framework and Plan-Do-Study-Act cycles, which included the addition of prompts on rounds, education, and documentation optimization.</p><p><strong>Results: </strong>Control chart analysis showed that the percent of surgical admissions with PT consults increased significantly from 25% to 95% and OT consults from 22% to 95% after project initiation. Time to consultation decreased significantly from 23 to 8 days for PT and from 23 to 9 days for OT consults. There was no significant difference in length of stay, time to first extubation, number of pressure injuries, fractures, or unplanned extubations.</p><p><strong>Conclusions: </strong>The adaptation and implementation of a standardized approach to early mobility in neonatal intensive care unit patients resulted in increased and more timely PT and OT consultations, leading to an overall improved focus on developmental care with minimal risks.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 1","pages":"e862"},"PeriodicalIF":1.1,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12928853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286533","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}