Pediatric quality & safety最新文献

{"title":"Improving Documentation of Pain Reassessment after Pain Management Interventions in the NICU.","authors":"Smitha Israel,&nbsp;Sofia Perazzo,&nbsp;Morgan Lee,&nbsp;Rachel Samson,&nbsp;Parissa Safari-Ferra,&nbsp;Ranjodh Badh,&nbsp;Solomon Abera,&nbsp;Lamia Soghier","doi":"10.1097/pq9.0000000000000688","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000688","url":null,"abstract":"<p><strong>Background: </strong>Neonates exposed to painful procedures require pain assessment and reassessment using nonverbal scales. Nurses perform initial assessments routinely, but reassessment is variable. The goal was to increase pain reassessments in neonates with a previous score of 4 or higher within 60 minutes from 50% to 75% within 12 months.</p><p><strong>Methods: </strong>After identifying key drivers, we tested several interventions using the IHI's Model for Improvement. The outcome measure was the rate of reassessments within 1 hour after scoring ≥4 on the Neonatal Pain Agitation and Sedation Scale (N-PASS). Duration of time between scoring and intervention was documented. Interventions included electronic health record (EHR) changes, direct communication with bedside nurses through text messages and emails, in-person education, and a yearly competency module. The process measure was the number of messages/emails to staff. Sedation scores were the balancing measure.</p><p><strong>Results: </strong>Baseline compliance was 50% with significant variability. A centerline shift occurred after the first intervention. After the first four interventions in the following 3 months, a 29% total increase occurred. Overall time-lapse between reassessments decreased from 102 to 90 minutes. Overall sedation scores decreased from -2.5 during the baseline to -1.7 during the sustain period. The goal of 75% pain reassessments was achieved and sustained for two years.</p><p><strong>Conclusions: </strong>Automated tools such as the trigger report provided data that increased noncompliance visibility. Real-time and personalized reminders and education improved awareness and set the tone for culture change. Electronic health record reminders for reassessments and standardized annual education helped in sustaining change.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e688"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161170","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 Situational Awareness to Decrease Emergency ICU Transfers for Hospitalized Pediatric Cardiology Patients.","authors":"Tara C Cosgrove,&nbsp;Robert J Gajarski,&nbsp;Kevin F Dolan,&nbsp;Stephen A Hart,&nbsp;Kaitlin E L'Italien,&nbsp;Stacy Kuehn,&nbsp;Stephanie Ishmael,&nbsp;Jessica L Bowman,&nbsp;Jill A Fitch,&nbsp;Brittney K Hills,&nbsp;Ryan S Bode","doi":"10.1097/pq9.0000000000000630","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000630","url":null,"abstract":"<p><strong>Introduction: </strong>Failure to recognize and mitigate critical patient deterioration remains a source of serious preventable harm to hospitalized pediatric cardiac patients. Emergency transfers (ETs) occur 10-20 times more often than code events outside the intensive care unit (ICU) and are associated with morbidity and mortality. This quality improvement project aimed to increase days between ETs and code events on an acute care cardiology unit (ACCU) from a baseline median of 17 and 32 days to ≥70 and 90 days within 12 months.</p><p><strong>Methods: </strong>Institutional leaders, cardiology-trained physicians and nurses, and trainees convened, utilizing the Institution for Healthcare Improvement model to achieve the project aims. Interventions implemented focused on improving situational awareness (SA), including a \"Must Call List,\" evening rounds, a visual management board, and daily huddles. Outcome measures included calendar days between ETs and code events in the ACCU. Process measures tracked the utilization of interventions, and cardiac ICU length of stay was a balancing measure. Statistical process control chart methodology was utilized to analyze the impact of interventions.</p><p><strong>Results: </strong>Within the study period, we observed a centerline shift in primary outcome measures with an increase from 17 to 56 days between ETs and 32 to 62 days between code events in the ACCU, with sustained improvement. Intervention utilization ranged from 87% to 100%, and there was no observed special cause variation in our balancing measure.</p><p><strong>Conclusions: </strong>Interventions focused on improving SA in a particularly vulnerable patient population led to sustained improvement with reduced ETs and code events outside the ICU.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e630"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/fd/pqs-8-e630.PMC10538891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161274","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":"Firearm Safety Screening in the Pediatric Hospital Setting: A Quality Improvement Initiative.","authors":"Elizabeth R Oddo, Neha Kumar, Annie L Andrews, Stephanie Kwon","doi":"10.1097/pq9.0000000000000689","DOIUrl":"10.1097/pq9.0000000000000689","url":null,"abstract":"<p><strong>Background: </strong>Firearm injuries are a leading cause of morbidity and mortality for US youth. Secure storage is protective against firearm injuries in children. Despite this evidence and national recommendations, rates of firearm safety screening among pediatric providers are low, particularly in the inpatient setting. Therefore, we aimed to increase the frequency of firearm safety screening among patients admitted to the Pediatric Hospital Medicine service.</p><p><strong>Methods: </strong>This project occurred in a tertiary pediatric hospital with a medium-sized pediatric residency program. The initial intervention was a firearm safety screening tool embedded into the electronic health record history and physical note template. Subsequent interventions included nursing education, monthly reminder emails, and gun violence discussions during intern orientation. Patients who screened positive were provided with educational materials and a free gun lock. Data collection occurred by chart review to determine the frequency of screening documentation in the H&P. A survey was also conducted among pediatric residents to identify persistent barriers to screening.</p><p><strong>Results: </strong>The percentage of inpatient firearm safety screening increased from 0.01% to 39% over 25 months, with a centerline shift noted after 2 months. Residents cited a lack of time with the patient and a belief that it was not the appropriate time to screen as persistent barriers to screening.</p><p><strong>Conclusions: </strong>This study identified an effective approach to improving firearm safety screening in an academic pediatric hospital. Hospitalization represents a unique opportunity for firearm safety screening and counseling, and inpatient providers should feel empowered to intervene in this setting.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e689"},"PeriodicalIF":1.2,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175423","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":"Transthoracic Echocardiography in the Preoperative Assessment of Newborn Coarctation: Limiting Risks Associated with Advanced Imaging Techniques.","authors":"Christina L Benjamin,&nbsp;Erik G Ellsworth,&nbsp;Roosevelt Bryant,&nbsp;Deepti P Bhat","doi":"10.1097/pq9.0000000000000682","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000682","url":null,"abstract":"<p><p>A newborn male child with prenatally identified aortic arch hypoplasia presented to our facility for cardiac management. He had been started on prostaglandins at the delivery facility and was subsequently placed on a high-flow nasal cannula due to associated apnea. On the day of life three, the patient underwent cardiac computed tomography scan for delineation of his anatomy. The patient remained intubated after his imaging study in anticipation of surgical intervention, which took place at the age of 5 days. The patient required a peritoneal dialysis catheter placement 2 days after his procedure due to oliguria. He progressed into renal failure requiring continuous renal replacement therapy. This patient was subsequently discussed at our departmental morbidity and mortality conference. The short time frame between contrast administration for the computed tomography and surgical intervention was thought to have contributed to his renal failure. We discussed the adequacy of transverse aortic arch imaging by echocardiogram and the utility of advanced imaging in the fragile neonatal period. This discussion resulted in our department asking, \"Is transthoracic echocardiography accurate when diagnosing and characterizing aortic coarctation at our institution? Are advanced imaging studies necessary in instances of simple coarctation?\"</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e682"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167350","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 Radiation Exposure to the Abdomen in Children with Chronic Constipation.","authors":"Bennet C Chun,&nbsp;Margarita Chmil,&nbsp;Lynne Ruess","doi":"10.1097/pq9.0000000000000681","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000681","url":null,"abstract":"<p><strong>Background: </strong>Bowel management for children with chronic constipation may include repeated single-view abdomen radiographs (AXR) to monitor treatment success. Only one image of the abdomen is needed to include most of the colon, but technologists often make a second (or even third) exposure to be sure they have imaged the entire abdomen. Our quality improvement project aimed to reduce radiation exposure by decreasing the frequency of >1 exposure performed for AXR orders in children with chronic constipation from 27% to <10% by December 2022 and sustain.</p><p><strong>Methods: </strong>We counted baseline (01/2020-11/2020) and intervention (12/2020-5/2023) examinations with >1 exposure. Initial interventions were a structured communication to technologists and an article in the monthly department newsletter and later, a technologist education module. Additional interventions included communication to radiologists, project updates and encouragement to all technologists, and individual technologist feedback. A statistical process control chart tracked data to study process changes over time.</p><p><strong>Results: </strong>During the baseline and intervention periods, 525/1944 and 1329/8334 examinations, respectively, had >1 exposure performed for AXR orders. Interventions created 2 centerline shifts. Overall, examinations with >1 exposure decreased from 27% to 13.5%.</p><p><strong>Conclusions: </strong>Frequency of >1 exposure performed for AXR orders in children with chronic constipation decreased from 27% to 13.5% through education and communication. This was sustained. We plan to assign training modules for all new technologists, policy reminders (annual training in odd years) for all technologists, and continue individualized learning opportunities.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e681"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/31/pqs-8-e681.PMC10538869.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176087","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 Tool School: Improving the Delivery of Quality Improvement Education in a Children's Hospital.","authors":"James Gallup,&nbsp;Don Buckingham,&nbsp;Kevin Dolan,&nbsp;Charlie Macias","doi":"10.1097/pq9.0000000000000680","DOIUrl":"10.1097/pq9.0000000000000680","url":null,"abstract":"<p><strong>Background: </strong>In 2013, Nationwide Children's Hospital's (NCH) Quality Tool School (QTS) was created as an initial Quality Improvement educational series, composed of three separate classes, totaling 5.5 hours of hands-on QI training. QTS complemented the NCH 40-hour Quality Improvement Essentials course.</p><p><strong>Methods: </strong>Over 10 years, the series went through three phases of aims: <i>Phase 1</i>: develop and implement three core courses (Project Tools, Excel, and Control Charts); <i>Phase 2</i>: have participants complete the entire series of all three classes; <i>Phase 3</i>: have participants who complete the entire series of all three classes demonstrate the application of learning through involvement in a quality improvement project.</p><p><strong>Results: </strong>Since initiation, QTS has provided an educational entry point for 1428 NCH employees to participate in QI projects and teams. QTS has shown statistically significant improvement in 2 of the 3 principal aims. The Phase 1 <i>metric of average monthly one-class participation completion percentage</i> showed a statistically significant centerline shift from 9 to 16 students in October 2018. The Phase 3 metric <i>Percentage of QTS participants completing the QTS series of classes and then participating in a QI team</i> began in 2016 with a baseline of 42%. A centerline shift from 42% to 63% occurred in Q4 2018.</p><p><strong>Conclusions: </strong>QTS can provide QI education to healthcare system employees using limited resources. Organizations that strategically integrate a culture of QI into core beliefs can realize substantial improvement gains.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e680"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10538879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154051","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":"Pediatric ED Saves: Analyzing the ED Screen of Direct Admissions.","authors":"Fatima Ramirez-Cueva, Gary Prusky Grinberg, Ann Marie Kuchinski, Robert Gibson, Hongyan Xu, Li Fang Zhang, Desiree Seeyave","doi":"10.1097/pq9.0000000000000678","DOIUrl":"10.1097/pq9.0000000000000678","url":null,"abstract":"<p><p>Direct admissions (DAs) are a routine hospital entry portal with few guidelines to assess patient safety during this process. This study assessed the effectiveness of an institutional screen for patients presenting as DA. It investigated patient variables that may predict appropriateness for DA and those at high risk for deterioration.</p><p><strong>Methods: </strong>The study includes patients who received the institutional screen between June 1, 2019, and May 31, 2020. We placed charts into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to pediatric intensive care unit within 6 hours). We assessed effectiveness by calculating sensitivity, specificity, and predictive values. We used comparative analysis between groups to identify patients safe for DA and those at high risk for deterioration.</p><p><strong>Results: </strong>The screen was 80% sensitive and 100% specific, predicting 97.7% of stable patients. Of the 652 charts reviewed, 384 met the inclusion criteria. Group 1 (31.60, 26.45%, 5.23%) had lower respiratory rate, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO₂, group 1 (98.70) was higher than group 2 (96.03). For the Pediatric Early Warning Score, group 2 (1.72) was higher than group 1 (0.31) and group 3 (0.63).</p><p><strong>Conclusions: </strong>The institutional screen is an effective tool to identify patients presenting as DA needing immediate emergency department intervention and/or pediatric intensive care unit care. The screen benefits patients with a respiratory diagnosis, oxygen requirement, high respiratory rate or low SpO₂.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 4","pages":"e678"},"PeriodicalIF":1.2,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/37/pqs-8-e678.PMC10402936.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962133","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":"Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project.","authors":"Priyam Pattnaik,&nbsp;Suhas Nafday,&nbsp;Robert Angert","doi":"10.1097/pq9.0000000000000669","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000669","url":null,"abstract":"<p><p>Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children's Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans.</p><p><strong>Methods: </strong>We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change.</p><p><strong>Results: </strong>Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients.</p><p><strong>Conclusion: </strong>A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 4","pages":"e669"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171985","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 to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters.","authors":"Courtney M Brown,&nbsp;Beth Dillon,&nbsp;Christina Toth,&nbsp;Emily Decker,&nbsp;Robin N Alexander,&nbsp;Aarti R Chandawarkar,&nbsp;Stefanie Bester,&nbsp;Elizabeth Ricket,&nbsp;Dane A Snyder","doi":"10.1097/pq9.0000000000000679","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000679","url":null,"abstract":"<p><p>Children from households with a preferred language other than English are less likely to receive timely identification and treatment for developmental delay than children of native English speakers. In dismantling this inequity, the role of primary care pediatrics is to establish equitable systems for screening and referral. This project, conducted in a network of twelve pediatric primary care centers, focused on eliminating a small but systematic disparity in developmental screening rates between families who did and did not require interpreters (86% versus 92%). The specific aim was to increase developmental screen completion among patients needing interpreters from 86% to 92% of age-appropriate well-child visits.</p><p><strong>Methods: </strong>Data were extracted from the electronic health record (EHR) to measure the proportion of 9-, 18-, 24-, and 30-month well-child visits at which developmental screens were completed, stratified by interpreter need (n = 31,461 visits; 7500 needing interpreters). One primary care center tested small changes to standardize processes, eliminate workarounds, and leverage EHR features using the Institute for Healthcare Improvement's Model for Improvement. The QI team plotted screen completion on control charts and spread successful changes to all 12 clinics. Statistical process control evaluated the significance of changes in screening rates.</p><p><strong>Results: </strong>For patients needing interpreters, screen completion rose across all clinics from 86% to 93% when the clinics implemented the new process. Screen completion for patients not needing interpreters remained at 92%.</p><p><strong>Conclusion: </strong>A standardized process supported by the EHR improved developmental screening among patients needing interpreters, eliminating disparities.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 4","pages":"e679"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10402961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9960140","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 Postoperative Length of Stay for Idiopathic Scoliosis Patients using Quality Improvement Methodology.","authors":"Crystal Seilhamer,&nbsp;Kelly Miller,&nbsp;Jessica Holstine","doi":"10.1097/pq9.0000000000000672","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000672","url":null,"abstract":"<p><p>Approximately 1%-3% of the US population is diagnosed with scoliosis. In addition, 80% of those diagnosed have idiopathic scoliosis, with about 10% requiring surgical intervention. This Quality Improvement initiative aimed to reduce the length of stay (LOS) after posterior spinal fusion for these patients. According to the Pediatric Health Information System, our institution had a poorer performance, with an actual LOS greater than or equal to the expected LOS compared with peer institutions.</p><p><strong>Methods: </strong>The aim was to increase the percentage of idiopathic scoliosis patients with a procedure to discharge LOS of less than or equal to 4 days after posterior spinal fusion from 39.13% to 90%. Interventions included implementing a new pain management protocol, a daily checklist, education on expectations of postoperative pain, and updated order sets.</p><p><strong>Results: </strong>Interventions improved patients discharged in less than 4 days from 39.13% to 93.48% (<i>P ≤</i> 0.001), reducing the average postprocedure LOS from 4.93 to 2.59 (<i>P</i> ≤ 0.001) days. A key process measure tracked was the percentage of patients off the patient-control analgesia pump by postoperative day 2, which increased from 13% to 97.75% (<i>P ≤</i> 0.001). These improvements did not affect the balancing measure of readmissions or Emergency Department visits for pain.</p><p><strong>Conclusions: </strong>By implementing a more standardized pathway, including a patient-focused daily checklist for providers and families, we established expectations for LOS and pain. This checklist and updates to the pain management protocol successfully reduced the length of stay in idiopathic scoliosis patients after posterior spinal fusion.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 4","pages":"e672"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/8e/pqs-8-e672.PMC10403041.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9962134","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}