Pediatric quality & safety最新文献

{"title":"A Standardized Approach to Transition Improves Care of Young Adults with Inflammatory Bowel Disease.","authors":"Daphna Katz, Stephanie Lee, Vidiya Sathananthan, Liz Bayes Santos, Amber Langshaw","doi":"10.1097/pq9.0000000000000786","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000786","url":null,"abstract":"<p><strong>Introduction: </strong>Young adults with inflammatory bowel disease (IBD) are at the risk of poor outcomes when transferring to adult providers. We aimed to increase the percentage of patients with 14-17 years of age undergoing the transition of care and the percentage of patients 18-21 years of age initiating the transfer of care to 50% for 12 months. Our goal was also to improve patient satisfaction with the transfer process. Our balancing measure was not to increase the duration of IBD visits.</p><p><strong>Methods: </strong>We implemented 3 interventions through iterative plan-do-study-act cycles. To understand the impact of the interventions for 12 months, we used statistical process control charts. The duration of IBD visits was used as a balancing measure. We administered an anonymous satisfaction survey through the electronic health record.</p><p><strong>Results: </strong>Total transition discussions increased to a mean of 38% (n = 68). Transition discussions with patients 14-17 years of age increased from baseline, though not consistently. Patients 18-21 years of age initiating transfer of care increased to a mean of 5% (n = 1) following the first intervention and to a mean of 30% (n = 13) following our second and third interventions with special cause variation. There was no significant difference in the duration of IBD visits before and after the intervention period (<i>P</i> = 0.54). No patients were dissatisfied following our interventions.</p><p><strong>Conclusions: </strong>We saw improved transition discussions and transfer initiation rates by implementing the first steps of a new process to transition young adults with IBD.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e786"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960033","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":"Improved Adherence to Lipid Screening in the Pediatric Cardiology Clinic: A Quality Improvement Project.","authors":"Rachel A Magnan, Thomas Murphy, Lauren Rosenthal, Aparna Prasad, Anjali Chelliah, Stuart Kaufman, Donna Timchak, Lindsey McPhillips, Saira Siddiqui","doi":"10.1097/pq9.0000000000000781","DOIUrl":"10.1097/pq9.0000000000000781","url":null,"abstract":"<p><strong>Introduction: </strong>Lipid screening identifies at-risk patients to facilitate cardiovascular risk reduction. National pediatric guidelines recommend universal lipid screening between 9-11 and 17-21 years of age. We aimed to improve adherence to lipid screening for all age-appropriate outpatient pediatric cardiology visits from a baseline of 35% to 90% between November 2021 and July 2023.</p><p><strong>Methods: </strong>All outpatient visits for patients 9-11 and 17-21 years were included. Chart review and an Epic electronic health record report identified patients screened, lipid test results, and need for further testing. A P-chart was generated. After establishing a baseline for 8 weeks, interventions, including an Epic dot phrase, group and individual feedback, and Epic best practice alert (BPA), were incorporated via plan-do-study-act cycles. Balancing measures included anonymous provider surveys on visit length and experience.</p><p><strong>Results: </strong>More than 1,700 patient visits were included. At baseline, 35% of all age-appropriate patients were screened. The Epic dot phrase prompted a positive shift with a new mean of 59% screened. Another change occurred after the BPA alert, with an increase in screening to 84%. Lipid screening prompted by this initiative found that 38% of those with testing results in Epic had abnormal results requiring follow-up. Providers did not report a significant change in visit length due to screening.</p><p><strong>Conclusions: </strong>Quality improvement interventions improved adherence to universal lipid screening guidelines. The Epic dot phrase and BPA facilitated positive shifts. These simple interventions can be spread to other practices to improve adherence to lipid screening and other guidelines.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e781"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904366","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 Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.","authors":"Summit H Shah, Cody M Young, Jessica Morrison, Margarita Chmil, Lynne Ruess, Rajesh Krishnamurthy","doi":"10.1097/pq9.0000000000000779","DOIUrl":"10.1097/pq9.0000000000000779","url":null,"abstract":"<p><strong>Introduction: </strong>Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain.</p><p><strong>Methods: </strong>We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old. We developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to reduce scan time and control for factors that decrease image quality. Additional interventions included technologist training, communication to radiologists and clinicians, and eliminating a default request for sedation accompanying the electronic order for most thoracic CT scans. A statistical process control chart tracked data to study process changes over time.</p><p><strong>Results: </strong>During the baseline and intervention periods, 232 of 357 and 217 of 794 scans required sedation. Interventions created 2 centerline shifts. Overall, thoracic CT scans in children 0-4 years old requiring sedation decreased from 65% to 24% and was sustained 5 years later. No patients during the baseline period, one (1 of 794, 0.1%) during the intervention period and 2 (2 of 480, 0.4%) during the audit period 5 years later, initially had nondiagnostic nonsedated scans that required an additional scan with sedation.</p><p><strong>Conclusions: </strong>We developed a volumetric target-mode electrocardiogram-gated CT protocol, eliminated default sedation ordering, and trained and educated staff to reduce sedation in young children undergoing thoracic CT scans. The frequency of sedation for thoracic CT in children 0-4 years old decreased from 65% to 24% and was sustained after revising imaging parameters and eliminating a default sedation order.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e779"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904373","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 Premedication for Neonatal Intubation: A Quality Improvement Initiative.","authors":"Michelle H Lucena, Toshiba Morgan-Joseph, Alecia Thompson-Branch","doi":"10.1097/pq9.0000000000000778","DOIUrl":"10.1097/pq9.0000000000000778","url":null,"abstract":"<p><strong>Introduction: </strong>Endotracheal intubation is frequent in the neonatal intensive care unit (NICU) but may result in neonatal distress and instability. Premedication reduces adverse effects, such as hypoxia, bradycardia, and pain. The Specific, Measurable, Achievable, Relevant and Time-Bound aim for this project was to increase premedication use for nonemergent neonatal intubation in a specific NICU from 22% to 80% from March 2021 to May 2023.</p><p><strong>Methods: </strong>We use quality improvement methodology to explain our theory for improvement. Our key driver diagram depicts this initiative's aims, key drivers, and interventions to increase premedication use for neonatal intubation. We defined exclusion criteria and medications, and one author collected demographic data retrospectively after the procedure. The stakeholders summarized the baseline data, performed plan-do-study-act cycles, and showed outcome measures in a statistical process control chart. Statistical analysis used Fisher's exact test to compare categorical variables.</p><p><strong>Results: </strong>Between 2021 and 2023, 333 infants underwent endotracheal intubation; 130 infants were included. The most common indication for intubation was hypoxemic respiratory failure-52% (68/130). Premedication use increased from 22% to 52%. Among the exclusion criteria, the most common indication for nonpremedication was intubation in the delivery room, 38.4% (78/203). In the premedication group, intubation on the first attempt occurred in 77.6% (52/67) of the cases, versus the nonpremedication group, 66.7% (32/48) (<i>P</i> = 0.3).</p><p><strong>Conclusions: </strong>Premedication for neonatal intubation increased by 30%, although we did not reach the desired 80% goal. Establishing a premedication bundle, alongside a unit-specific protocol and effective teamwork, marks the initial stride toward enhancing analgesia/sedation practices in the NICU.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e778"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904368","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 Intubations and Related Risks in Neonates with Retinopathy of Prematurity Undergoing Laser Photocoagulation.","authors":"Vilmaris Quinones Cardona, Emma McNell Byrne, Novisi Arthur, Megan Young, Diane Lavery, Amanda Carroll, Swosti Joshi, Folasade Kehinde, Ogechukwu Menkiti","doi":"10.1097/pq9.0000000000000780","DOIUrl":"10.1097/pq9.0000000000000780","url":null,"abstract":"<p><strong>Introduction: </strong>Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022.</p><p><strong>Methods: </strong>We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020. Outcome, process, and balancing measures tracked the efficacy and safety of the quality improvement project.</p><p><strong>Results: </strong>We reduced the percentage of infants requiring intubation for laser photocoagulation from 100% (8/8) to 10% (1/10). We reduced the average time to return to baseline respiratory status from 224.1 to 33.8 hours (9.3d to1.4 d). Cardiorespiratory index scores slightly increased (1 to 1.2), and pain scores remained unchanged after interventions.</p><p><strong>Conclusions: </strong>A multidisciplinary team approach using a deep sedation guideline and noninvasive ventilation can safely reduce the requirement for intubation during laser photocoagulation with a faster return to baseline respiratory status.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e780"},"PeriodicalIF":1.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904371","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 to Design and Evaluate an Outpatient Day Treatment Pathway for Pediatric Patients with Diabetes Mellitus Requiring Insulin Initiation.","authors":"Svetlana Azova, Charumathi Baskaran, Sara Einis, Jennifer Fortin, Marisa Silva, Miriam Gorman, Benjamin Ethier, Sonal Nanavati, Olivia Sterns, Katharine Garvey, Erinn T Rhodes","doi":"10.1097/pq9.0000000000000776","DOIUrl":"10.1097/pq9.0000000000000776","url":null,"abstract":"<p><strong>Introduction: </strong>Education and management of children with new-onset or established diabetes mellitus (DM) requiring insulin initiation do not always require hospitalization. We developed a pathway for outpatient day treatment of select patients after initial evaluation in the emergency department (ED) at a pediatric, tertiary care academic medical center.</p><p><strong>Methods: </strong>A multidisciplinary team identified key initial eligibility criteria for outpatient day treatment for insulin initiation, including absence of diabetic ketoacidosis, age ≥3 years, and plasma beta-hydroxybutyrate (BOHB) <1 mmol/L. Electronic medical record reviews and surveys administered to endocrine providers determined exclusions or reasons for nonparticipation. Refinement of the pathway occurred through iterative plan-do-study-act cycles. Statistical process control evaluated the uptake among eligible patients.</p><p><strong>Results: </strong>We launched the pathway in September 2020. Of 534 patients presenting to the ED with new-onset or established DM requiring insulin initiation in the first 2.5 years, 198 were potentially eligible for day treatment. Of these, 65 children (33%) completed the pathway. One additional patient was hospitalized following Day 1 of education due to newly identified psychosocial stressors. The increase of BOHB cutoff to 1.5 mmol/L and the option of rapid-acting insulin bolus for borderline BOHB resulted in a significant shift in utilization from a mean of 24.4% to 41.1%. Persistent barriers to participation include limited appointment availability, weekend presentation, and patient/family concerns.</p><p><strong>Conclusions: </strong>Outpatient day treatment was successful for select pediatric patients with new-onset or established DM requiring insulin initiation. However, this approach necessitates flexible resources and supportive patient messaging.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e776"},"PeriodicalIF":1.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683714","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":"Implementation of a Neonatal Hyperbilirubinemia Clinical Pathway in a Pediatric Emergency Department.","authors":"Collin R Miller, Catherine Haut, Arezoo Zomorrodi, Karina Chara, Janice Wilson","doi":"10.1097/pq9.0000000000000774","DOIUrl":"10.1097/pq9.0000000000000774","url":null,"abstract":"<p><strong>Background: </strong>High volumes and competing priorities delay care initiation for neonatal hyperbilirubinemia within the pediatric emergency department (ED). Our freestanding children's hospital developed a quality improvement project to implement a nurse-initiated neonatal hyperbilirubinemia clinical pathway (CP) intended to decrease treatment initiation and intravenous fluid (IVF) rates.</p><p><strong>Methods: </strong>A multidisciplinary team used the model for improvement to delineate and address key drivers of treatment delays. The team established a nurse-driven CP and enhanced the electronic health record to support and enforce new workflows, which included capillary specimen collection and phototherapy initiation before the first provider assessment. IVF criteria and laboratory evaluation were standardized. The primary aim was to decrease the time to initiation of phototherapy from a mean of 136 to 60 minutes after ED arrival for 6 months. The secondary aim was to decrease the proportion of patients obtaining IVF from 31% to 15% for the same time frame.</p><p><strong>Results: </strong>ED arrival to phototherapy initiation decreased from 136 to 49 minutes. The IVF rate decreased from 31% to 12%. ED length of stay decreased from 185 to 122 minutes. Hospital length of stay remained unchanged.</p><p><strong>Conclusions: </strong>A nurse-initiated CP for neonates with hyperbilirubinemia improved time-to-care initiation and ED throughput while decreasing unnecessary IVF administration.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e774"},"PeriodicalIF":1.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683711","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":"The Business Case for Simulation-based Hospital Design Testing; $90M Saved in Costs Avoided.","authors":"Nora Colman, Christopher Chelette, Jayne Woodward, Misty Chambers, Kimberly Stanley, Sarah Walter, Vanessa Lampe Heimbuch, Caitlin Webster, Kiran Hebbar","doi":"10.1097/pq9.0000000000000775","DOIUrl":"10.1097/pq9.0000000000000775","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based hospital design testing (SbHDT) applied during the design of a healthcare facility ensures that the architectural design supports safe, high-quality, and efficient care delivery beyond applicable building code compliance. This prospective investigation assesses the financial impact of SbHDT in the form of cost avoidance.</p><p><strong>Methods: </strong>In designing a new free-standing 400+ bed children's hospital, SbHDT identified latent conditions early in the planning process to mitigate safety concerns related to the proposed design of 15 clinical areas. Architectural modifications were made to address concerns and resolve latent conditions before construction. The estimated cost of materials and labor to make an architectural change was documented for each architectural modification. Unit cost multiplied by unit count for each design element changed was summed together as total cost avoidance.</p><p><strong>Results: </strong>The cost to conduct the simulation was $1.6M (0.01% of overall project cost). Seven hundred twenty-two latent conditions were identified, and 57% of those latent conditions were mitigated by design changes. Ninety million dollars in costs were avoided by making design modifications before construction. Twenty-eight percent of latent conditions (n = 117) would have been cost-prohibitive to modify after construction.</p><p><strong>Conclusions: </strong>SbHDT harnessed evidence-based design to improve clinical care, optimize safety, and maximize investment. SbHDT was financially practical and had a significant impact on cost avoidance. Implementing SbHDT is associated with upfront costs, but long-term savings will accumulate over time through expenses avoided through mitigation of safety threats and operational savings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e775"},"PeriodicalIF":1.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11567707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649860","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":"Outpatient Management of Fever and Neutropenia in Low-risk Children with Solid Tumors: A Quality Improvement Initiative.","authors":"Wallace Bourgeois, Jonathan Paolino, Riley Garland, Kevin Campbell, Francesca Alvarez-Calderon, A Lindsay Frazier, Allison F O'Neill, Maya Ilowite, Chris I Wong","doi":"10.1097/pq9.0000000000000771","DOIUrl":"10.1097/pq9.0000000000000771","url":null,"abstract":"<p><strong>Background: </strong>Management of febrile neutropenia in pediatric oncology usually requires inpatient parenteral antibiotics after initial evaluation, but some patients at lower risk of sepsis could be safely managed outpatient. We describe a quality improvement project to increase outpatient management of fever and neutropenia.</p><p><strong>Methods: </strong>We designed a standardized algorithm for children with a solid tumor diagnosis and low risk for bacteremia. The aim was to achieve outpatient management for at least 80% of eligible patients within 20 months of project initiation. We used plan-do-study-act cycles to improve algorithm compliance, including optimizing medical record decision support, developing targeted educational materials and outreach, and restructuring outpatient processes to allow for close follow-up. We surveyed patients (age ≥12 y) and parents/caregivers to assess the impact of outpatient management.</p><p><strong>Results: </strong>The initiative led to 71% (n = 34) of eligible patients being managed as outpatients. Six percent (n = 2) of patients developed bacteremia, resulting in hospital admission. Fifteen of 26 parents/caregivers and five of 11 patients approached completed the survey. For the preferred setting of febrile neutropenia management, 83% of patients preferred to be home versus 40% of parents/caregivers. No patient expressed any of the three highest ratings in the question exploring fear regarding outpatient febrile neutropenia management versus 67% of parents/caregivers.</p><p><strong>Conclusions: </strong>Some children with a solid tumor diagnosis at low risk for bacteremia are safely managed for febrile neutropenia as outpatients. Targeted efforts to engage parents/caregivers early in this practice change are necessary for success.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e771"},"PeriodicalIF":1.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333934","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 Quality Improvement Initiative to Reduce Duplicate Inflammatory Marker Use.","authors":"Kathryn E Bakkum, Kathy H Stoner, David A Gannon, Thomas B Mike, Prabi Rajbhandari","doi":"10.1097/pq9.0000000000000769","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000769","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory markers (IMs) are often ordered in multiples, even though evidence suggests that this does not add any clinical benefit. The project aimed to reduce the number of duplicate IMs for patients by 10% in 12 months.</p><p><strong>Methods: </strong>We implemented a quality improvement (QI) project at our hospital, focusing on patients admitted to the pediatric hospital medicine service. The team chose the model for improvement as the QI methodology. Key interventions included ongoing provider education, integrating the project into the physician incentive plan, and reviewing disease-specific pathways. The primary outcome measure was \"duplicate IM use,\" which was defined as any two or more IMs (procalcitonin, C-reactive protein, or erythrocyte sedimentation rate) obtained on the same patient within 24 hours. The secondary outcome measure was any IM use during their stay, and the balancing measures were average complete blood count use, hospital length of stay, and 7-day readmission rate.</p><p><strong>Results: </strong>The baseline duplicate IM use, and any IM use was 43% and 19%, respectively. After the start of this QI project, duplicate IM use decreased to 12%, and the use of any IM also decreased to 12%. Complete blood count use varied from 11% to 24% during the project without obvious correlation to IM use. Hospital length of stay decreased from 2.5 to 2.6 days, and the 7-day readmission rate remained at 2.8%.</p><p><strong>Conclusions: </strong>The duplicate IM use and IM use were decreased without a concurrent increase in the balancing measures, indicating that a safe reduction of IM testing is feasible in inpatient pediatric care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e769"},"PeriodicalIF":1.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302887","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}