Pediatric quality & safety最新文献

{"title":"Assessment of a Stepwise Intervention to Improve Nurse-administered Penicillin Allergy Screening and De-labeling in Pediatric Inpatients.","authors":"Victoria J L Konold, Filmon Emnetu, Daniel Pak, Gabriel Mendoza, Adam W Brothers, Derry McDonald, Hector Valdivia, Scott J Weissman, Matthew P Kronman, Lori Rutman, Karyn Yonekawa","doi":"10.1097/pq9.0000000000000825","DOIUrl":"10.1097/pq9.0000000000000825","url":null,"abstract":"<p><strong>Introduction: </strong>Penicillins are first-line treatments for many childhood infections, but providers avoid them when patients report a penicillin allergy, although approximately 94% of these patients may tolerate penicillin. Patients with penicillin allergy labels often receive second-line antibiotics, which increases the risk of treatment failure and adverse events. To address this, programs to implement penicillin allergy de-labeling have increased; however, strategies to accomplish de-labeling most efficiently through guideline dissemination have not been well-studied.</p><p><strong>Methods: </strong>A multidisciplinary team created an evidence-based screening algorithm and standard protocol to screen eligible pediatric inpatients and de-label documented penicillin allergies. Plan-do-study-act cycles identified opportunities for improvement to the standard protocol.</p><p><strong>Results: </strong>We developed a screening tool to assess the risk of penicillin allergy and integrated it into the electronic health record for administration by clinical nurses. Follow-up actions, including de-labeling or further testing, are automatically communicated to the provider. Nurse-initiated screening increased from 3.8% to 28.1% after adding an electronic \"worklist task\" reminder. Allergy de-labeling demonstrated special cause variation following the dissemination of a standardized amoxicillin challenge order set and then again after a brief period of audit and feedback; however, the increases were not sustained.</p><p><strong>Conclusions: </strong>A nurse-administered screening questionnaire and protocolized follow-up actions can help achieve safe de-labeling at hospitals without a dedicated penicillin allergy service.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 4","pages":"e825"},"PeriodicalIF":1.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638872","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 Time to Initiation of Therapeutic Hypothermia in Inborn Infants with Hypoxic-ischemic Encephalopathy.","authors":"Alyssa Carlson, Allison Vale, Tracey Bell, Kristin Limpose, Anthony Piazza, Elizabeth K Sewell","doi":"10.1097/pq9.0000000000000826","DOIUrl":"10.1097/pq9.0000000000000826","url":null,"abstract":"<p><strong>Introduction: </strong>Earlier therapeutic hypothermia (TH) is associated with improved neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy (HIE). We aimed to increase the percentage of inborn infants with TH initiation before 3 hours from 25% to 75% within 12 months.</p><p><strong>Methods: </strong>This project took place at 2 academically affiliated Level III NICUs. We included infants inborn with moderate or severe HIE who met standard criteria for TH. The team developed a driver diagram and process map, which informed interventions. We compared data using descriptive statistics and Statistical Process Control charts.</p><p><strong>Results: </strong>Of the 70 included infants, 13 were in the baseline period, and 57 were in the implementation and sustainment period. There was a special cause variation that increased the centerline from 25% to 72%. The most common cause of initiation of TH after 3 hours of life was progression from mild to moderate HIE (39%). When infants with progression of encephalopathy were excluded, the central line further increased to 79%. In this refined cohort, the mean percentage of infants with TH initiated before 3 hours was 31%, 76%, and 80% in the baseline, implementation, and sustainment periods, respectively.</p><p><strong>Conclusions: </strong>Quality improvement methodology can reduce the time to TH initiation in inborn infants, which is associated with improved neurodevelopmental outcomes. A common reason for delayed TH initiation is progression from mild to moderate encephalopathy.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 4","pages":"e826"},"PeriodicalIF":1.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610539","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":"Standardization Improves Discharge Care Coordination for Children with Nasogastric Tubes.","authors":"Lisa M Rickey, Katharine Nagle, Julia Perkins, Caroline Kohler, Benjamin Ethier, Kristen Fontaine, Susan Matherson, Anne M Stack, Maireade E McSweeney","doi":"10.1097/pq9.0000000000000823","DOIUrl":"10.1097/pq9.0000000000000823","url":null,"abstract":"<p><strong>Introduction: </strong>Discharging patients with new nasogastric tubes (NGTs) for enteral nutrition at home is complex and requires intricate care coordination and education from a multidisciplinary team. We designed a quality improvement (QI) initiative to improve efficiency and decrease variation in care coordination for patients discharged with a new NGT. Our objective was to reduce mean modified hospital length of stay (mLOS) by 10% from baseline within 6 months and sustain improvement for 12 months.</p><p><strong>Methods: </strong>Applying the Model for Improvement, we used plan-do-study-act cycles to improve NGT discharge care coordination using a multidisciplinary team. Primary interventions rooted in Lean methodology included creating a standardized discharge algorithm, utilizing nurse practitioners as care coordination champions, routine consultation of an enteral tube service (ETS), and implementing a formula substitution guide. The primary outcome measure was mean mLOS. The process measure was the time from NGT placement to ETS consult. Balancing measures were ETS consult volume and 30-day healthcare reutilization. Statistical process control charts measured the impact of interventions.</p><p><strong>Results: </strong>Baseline mLOS decreased from 8.2 to 7.4 days with a sustained reduction in process variability over time. Time from NGT placement to ETS consult decreased from 4.1 to 3.0 days. There were no changes in 30-day healthcare reutilization or ETS consult volume over time.</p><p><strong>Conclusions: </strong>A multidisciplinary quality improvement initiative effectively improved complex NGT transitional care planning and was sustained over time.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 4","pages":"e823"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610540","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":"Using Quality Improvement Methods to Reduce Length of Stay with a Respiratory Therapist-driven Pathway for Asthma.","authors":"Katherine M Tang, Cloyde Mills, Teresa A McCann, Susan L Rosenthal, Jennifer Lee","doi":"10.1097/pq9.0000000000000817","DOIUrl":"10.1097/pq9.0000000000000817","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma pathways reduce hospital length of stay (LOS), and respiratory therapists (RTs) can optimize care. This study aimed to use quality improvement methods to implement an asthma-specific RT role and RT-driven asthma pathway. The SMART aim was to reduce LOS for pediatric patients admitted for asthma to the general inpatient units by 20% within 22 months.</p><p><strong>Methods: </strong>We included children 2-17 years of age who were admitted to a general inpatient unit for asthma. We excluded patients transferred from another hospital, initially admitted to the pediatric intensive care unit, or with comorbidities predisposed to severe respiratory illnesses. We used the Model for Improvement to design and study interventions. Key drivers focused on standardizing care, leveraging provider expertise, and supporting providers with education and technology. The outcome measure was LOS. The main process measure was the early transition to an albuterol metered-dose inhaler. Balancing measures were hospital reutilization rates and escalation of care. We used statistical process control charts and run charts to analyze the data.</p><p><strong>Results: </strong>The study included 743 patients, with 339 in the intervention period. The intervention group had a younger median age (4 [3, 7] versus 6 [3, 10] years, <i>P</i> < 0.001) and more publicly insured patients (84% versus 68%, <i>P</i> < 0.001). LOS decreased from 39.4 to 30.7 hours, achieving our SMART aim without adversely affecting the balancing measures.</p><p><strong>Conclusions: </strong>Quality improvement methodology aids in implementing an RT-driven asthma pathway on the pediatric floors to decrease LOS without adversely influencing hospital reutilization rates or transfers for escalation of care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e817"},"PeriodicalIF":1.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236157","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 Time to Analgesia for Sickle Cell Pain Episode Treatment in the Pediatric Emergency Department.","authors":"Amelia F Wong, Jaime K Otillio, Abby K Fahnestock, Christine M Smith, Michael R DeBaun, Emmanuel Volanakis, Lacey Noffsinger, Jeannie Byrd, S Barron Frazier","doi":"10.1097/pq9.0000000000000821","DOIUrl":"10.1097/pq9.0000000000000821","url":null,"abstract":"<p><strong>Introduction: </strong>Pain episodes are the most common emergency department (ED) presentation for patients with sickle cell disease (SCD). Prompt pain medication and frequent pain assessments are recommended. Our SMART aim was to reduce the time from ED rooming to first analgesia administration for children presenting with SCD pain from 50 to less than 30 minutes by June 2024.</p><p><strong>Methods: </strong>Children presenting to the ED with a diagnosis of SCD requiring opioids for pain were included. The primary outcome was time from rooming to analgesia. A key driver diagram, developed by a multidisciplinary team, informed our interventions and then implemented through plan-do-study-act cycles. Statistical process control charts were used to analyze data with Nelson rules to detect special cause variation. Secondary measures included frequency of pain assessments in the first 2 hours and ED length of stay.</p><p><strong>Results: </strong>From July 2020 to June 2024, there were 447 eligible encounters. Baseline data (n = 143) revealed an average time from ED rooming to analgesia of 50 minutes. Following interventions, including order set implementation, multidisciplinary collaboration, and incorporating the home action plan in the ED, special cause variation was detected with a centerline shift to 32 minutes. The median number of pain assessments in the first 2 hours of arrival improved from 2.2 to 2.7 with order set utilization. ED length of stay remained unchanged.</p><p><strong>Conclusions: </strong>Standardizing care with an order set increased the number of pain assessments. Incorporation of the SCD home pain action plan into the ED treatment pathway decreased the time to analgesia.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e821"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227800","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 Procedural Documentation of Newly Diagnosed Pediatric Inflammatory Bowel Disease Patients: A Single-center Quality Improvement Study.","authors":"Hamza Hassan Khan, Jordan S Whatley, Carmine Suppa","doi":"10.1097/pq9.0000000000000819","DOIUrl":"10.1097/pq9.0000000000000819","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn disease (CD), presents significant challenges in management, particularly regarding standardized endoscopic scoring. This study aimed to assess and improve procedural documentation practices among endoscopists managing newly diagnosed pediatric IBD (PIBD).</p><p><strong>Methods: </strong>This quality improvement project involved a preintervention review of records for newly diagnosed patients with PIBD from January 2022 to December 2022 and a postintervention review of records from March 2023 to March 2024. We evaluated procedural documentation practices pre- and postintervention using control charts. We conducted an educational session on standardized procedural documentation for endoscopists in March 2023. Standardized procedural documentation was defined as the Mayo endoscopic score for ulcerative colitis and the simple endoscopic score for CD. We displayed a reminder flow diagram on the computer used by endoscopists for their procedural documentation.</p><p><strong>Results: </strong>In the preintervention period (n = 29), endoscopists used standardized documentation in 21% of cases (6/29). Postintervention (n = 43), standardized documentation use increased to 72% (31/43), demonstrating a 51% improvement. Subgroup analysis revealed variable adoption rates, with 100% for IBD-undetermined and 0% for patients with very early onset IBD. Control p-chart revealed a downward trend in the defect rate in the later months, suggesting improved adherence.</p><p><strong>Conclusions: </strong>Our initiative significantly enhanced the utilization of standardized endoscopic documentation among endoscopists for newly diagnosed patients with PIBD. This improvement underscores the effectiveness of structured educational strategies in promoting adherence to best practices. Future efforts should focus on sustaining these gains and addressing subgroup-specific challenges to optimize patient care in IBD management.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e819"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227799","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":"A Partner Hospital Intervention to Decrease Readmissions for Newborn Hyperbilirubinemia.","authors":"Laura P Chen, Elizabeth M Goetz, Ann H Allen, Daniel J Sklansky, Kirsten Koffarnus, Kristin A Shadman","doi":"10.1097/pq9.0000000000000820","DOIUrl":"10.1097/pq9.0000000000000820","url":null,"abstract":"<p><strong>Introduction: </strong>The 2022 American Academy of Pediatrics Clinical Practice Guideline revision for newborn hyperbilirubinemia raised thresholds for phototherapy initiation. Our global aim was to align care across 2 partner hospitals with the revised clinical practice guideline. Our aim was to decrease readmissions for phototherapy by 20% in 12 months.</p><p><strong>Methods: </strong>Using the model for improvement, a stakeholder team conducted this quality improvement initiative at our state's largest birthing hospital and partner pediatric hospital. We collected baseline data from January to August 2022 and implementation data from September 2022 to February 2024. We included newborns 14 days or younger readmitted to the pediatric hospital general ward for phototherapy. Interventions included provider education, local clinical guidelines, and electronic medical record updates. Outcome measures of count and rate of monthly readmissions were tracked on a C chart and U chart, respectively. The process measure of time between occurrence of subthreshold phototherapy initiation was tracked on a t-chart. The balancing measure of the length of stay was analyzed on an XbarS chart. We assessed special cause variation using established statistical process control chart rules.</p><p><strong>Results: </strong>A total of 10,620 deliveries occurred, with 104 readmissions for hyperbilirubinemia. The mean count of monthly readmissions decreased from 5.8 to 2.4 from the baseline to the implementation period; the rate of monthly readmissions decreased from 1.4% to 0.6%. Mean days between the occurrence of subthreshold phototherapy initiation increased from 15.5 to 62.5 days. The average length of stay remained at 21.5 hours.</p><p><strong>Conclusions: </strong>This partner hospital initiative significantly decreased newborn hyperbilirubinemia readmissions.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e820"},"PeriodicalIF":1.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182564","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 the Use of Albuterol Nebulizer Solution in the Management of Asthma Exacerbations in the Emergency Department.","authors":"Adjoa A Andoh, Charles Hardy, Laura Evans, Amber Milem, Courtney Whitacre, Laura Rust, Amberley Masa, Gregory Stewart","doi":"10.1097/pq9.0000000000000814","DOIUrl":"10.1097/pq9.0000000000000814","url":null,"abstract":"<p><strong>Introduction: </strong>During a nationwide surge in asthma exacerbations in the fall of 2022, there was a critical shortage of albuterol nebulizer solution, requiring our institution to explore ways to conserve nebulized albuterol. The metered-dose inhaler (MDI) and vibrating mesh nebulizer (VMN) offer more efficient methods of albuterol administration. We aimed to incorporate alternative albuterol administration methods within our emergency department (ED) to decrease the amount of nebulized albuterol solution administered for asthma exacerbations.</p><p><strong>Methods: </strong>We assessed the average cumulative albuterol dose per patient encounter 28 months before our interventions. Our multidisciplinary team developed interventions using QI methods, modifying the ED asthma clinical practice guideline and associated electronic order set to incorporate the MDI and VMN. The primary outcome was decreasing the average cumulative dose of nebulized albuterol per patient encounter. Balancing measures include ED length of stay (LOS), hospital admissions, and revisit rates within 24 hours.</p><p><strong>Results: </strong>This project began in May 2023, with 2,781 patients included in the subsequent 16 months postproject implementation. We identified special cause variation in the average dose of albuterol nebulization decreasing from 17.42 to 11.57 mg per encounter, which was sustained postintervention. Although we saw decreased ED LOS for discharged patients, there were no changes in overall ED LOS, admissions, or revisit rates.</p><p><strong>Conclusions: </strong>Changes to the clinical practice guidelines and order set incorporating alternative albuterol administration methods led to a sustained decrease in the average dose of nebulized albuterol used per patient encounter.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e814"},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129772","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 HRO Principles under Stress: A Hospital's Journey toward High Reliability.","authors":"Caitlin Naureckas Li, Hannah Stuart, Michaeleen Green, Abbey Studer, Sangeeta Schroeder, Derek Wheeler","doi":"10.1097/pq9.0000000000000816","DOIUrl":"10.1097/pq9.0000000000000816","url":null,"abstract":"<p><strong>Introduction: </strong>High reliability organization principles are an established approach to reducing risk in highly complex environments. Our hospital recognized an opportunity to integrate these principles during the disruption of the COVID-19 pandemic.</p><p><strong>Methods: </strong>This work took place at our quaternary pediatric hospital. Interventions fell within 3 categories: optimizing structure for success, measurement and transparency, and assigning accountability and empowering all. Our outcome measures of interest were several significant safety events meeting predefined definitions per month, and our process metric was the total number of events reported in our safety event reporting system.</p><p><strong>Results: </strong>Following multiple cycles of interventions, the U chart of high-impact safety events per month demonstrated a centerline shift from 5.6 to 8.5 events per 10,000 adjusted patient days in April 2021 and a subsequent shift down to 5.9 events per 10,000 adjusted patient days in March 2023. A U chart of safety reports showed a decrease from 47.2 to 29.9 events per 1,000 adjusted patient days in April 2020, subsequently increasing to 39.9 events per 1,000 adjusted patient days in March 2022.</p><p><strong>Conclusions: </strong>Through interventions focused on high reliability organization principles, our hospital successfully increased the detection of high-impact safety events and then decreased the number of these serious events. We implemented these interventions despite the disruptions of the COVID-19 pandemic, and they have served as a protective mechanism during subsequent system stressors.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e816"},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129775","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 Computed Tomography Use for Appendicitis Evaluation in a Pediatric Emergency Department: A Multidisciplinary Quality Improvement Initiative.","authors":"Jennifer Hockenbury, Monica E Lopez, Caroline M Godfrey, Martin L Blakely, Melissa Danko, Marta Hernanz-Schulman, S Barron Frazier","doi":"10.1097/pq9.0000000000000808","DOIUrl":"10.1097/pq9.0000000000000808","url":null,"abstract":"<p><strong>Introduction: </strong>Appendicitis is the most common pediatric surgical emergency, and computed tomography (CT) remains an overused diagnostic test for appendicitis. Our institutional rate of CT utilization for suspected appendicitis was higher than in peer children's hospitals, so we aimed to reduce CT utilization during the evaluation of pediatric appendicitis from 31.3% to 15% within 12 months.</p><p><strong>Methods: </strong>From September 2021 to October 2022, we conducted a multidisciplinary quality improvement initiative among patients evaluated for appendicitis in the pediatric emergency department (PED). Interventions included standardizing evaluation with a clinical practice guideline, an order set in the electronic medical record for clinical decision support, and radiologist use of an ultrasound report template. The primary measure was the percentage of patients undergoing evaluation for appendicitis who received an abdominal CT scan. Process measures were the timing of surgical consultation and ultrasound report template use. Balancing measures included negative pathology appendectomies and PED return visits within 72 hours with subsequent appendicitis diagnosis. We analyzed data using statistical process control charts and Nelson rules to detect special cause variation.</p><p><strong>Results: </strong>We evaluated a total of 2,010 patients for acute appendicitis, with 624 representing baseline encounters with a CT rate of 31.3%. Quality improvement interventions reduced the CT rate to 12.1% sustained for 10 months without impacting the rate of negative pathology appendectomy or PED return visits within 72 hours.</p><p><strong>Conclusions: </strong>Quality improvement methodology led to a sustained reduction in CT utilization for patients undergoing evaluation for appendicitis in a PED.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 3","pages":"e808"},"PeriodicalIF":1.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103285","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}