Pediatric quality & safety最新文献

{"title":"Improving Access to Early Developmental Evaluation in Academic Primary Care Centers.","authors":"Zeina M Samaan, Pamela Williams-Arya, Kristen Copeland, Mary Carol Burkhardt, Jayna Schumacher, Jennifer Hardie, Cynthia White, Allison Reyner, Makeba Taylor, Jennifer Ehrhardt","doi":"10.1097/pq9.0000000000000789","DOIUrl":"10.1097/pq9.0000000000000789","url":null,"abstract":"<p><strong>Introduction: </strong>Developmental disorders (DDs) affect approximately 1 in 6 children in the United States. Early identification and treatment improve developmental outcomes and child and family functioning. Disparities exist in the diagnosis of DD that leads to inequitable access to developmental services during important periods of neuroplasticity. Improve access to the developmental and behavioral pediatrics (DBP) clinic for developmental evaluation when developmental delays occur among children 3-5 years of age by increasing the percentage of children scheduled for and completing an initial visit in 90 days from 20% to 40%.</p><p><strong>Methods: </strong>We used the Institute of Health Improvement model, executed mapping failure modes, created a key driver diagram and conducted plan-do-study-act cycles. We plotted data over time in a statistical control chart. The key intervention was an expedited, collaborative referral and scheduling process developed, tested, and implemented by the general pediatric clinic and DBP stakeholders. Additional interventions included reminder notifications and calls to patients who missed appointments.</p><p><strong>Results: </strong>The percentage of patients referred to DBP who scheduled and completed their initial visit in DBP within 90 days increased from 20% to 40%. DBP clinicians suspecting that patients had global developmental delay and/or autism spectrum disorder at the initial DBP visit referred them for more extensive developmental testing with psychology and speech-language providers.</p><p><strong>Conclusions: </strong>Access to developmental evaluation for preschool-aged children at risk for delayed diagnosis and treatment was improved using quality improvement methodology focused on flexible and creative priority scheduling practices from within the medical home.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e789"},"PeriodicalIF":1.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973628","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 Unnecessary Resource Utilization for New-onset, Unprovoked, Afebrile Seizure in the Emergency Department.","authors":"Laura A Santry, Kathryn Giordano, Andrew Mower, Jennifer Hubbard, James Thomas, Rodney C Scott, Karina Chara, James Zent, Arezoo Zomorrodi","doi":"10.1097/pq9.0000000000000787","DOIUrl":"10.1097/pq9.0000000000000787","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric seizures account for approximately 1% of emergency department (ED) presentations. Laboratory evaluation and emergent electroencephalogram (EEG) are not indicated in patients with a new-onset, unprovoked, afebrile seizure with a normal physical examination. This study aimed to reduce unnecessary ED resource utilization.</p><p><strong>Methods: </strong>Through plan-do-study-act cycles from March 2021 to July 2023, a multidisciplinary team implemented change concepts, including creating a clinical pathway and supporting order sets, scheduling outpatient EEGs from the ED, and automating messages to the neurology team to ensure patient follow-up. The primary outcome measure was the percentage of qualified patients who received an EEG in the ED. Secondary outcome measures were the percentage of patients who had ED complete blood counts or neurology consults, the room-to-discharge time in minutes, and healthcare cost per patient. The balancing measure was the 30-day ED bounce-back rate.</p><p><strong>Results: </strong>Thirty-four and 99 patients met the inclusion criteria for the baseline and implementation phases, respectively. ED EEGs decreased from 59% to 1%. Complete blood counts and neurology consults decreased from 50% to 16% and 90% to 31%, respectively. Room-to-disposition time decreased from 308 to 203.5 minutes. Preliminary healthcare cost per patient decreased by $630. The 30-day bounce-back rate increased from 0% to 8%.</p><p><strong>Conclusions: </strong>Implementing a new-onset seizure pathway decreased ED resource utilization, shortened room-to-discharge time, and lowered healthcare costs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e787"},"PeriodicalIF":1.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973616","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 Surgical Site Infections in Pediatric Patients Undergoing Cardiothoracic Surgery.","authors":"Cassidy Golden, Kathy Murphy, Joshua M Rosenblum, Charlotta Eriksson, Parker Dunaway, Mary Lukacs, Lisa Newberry, Michelle E Gleason, Christina J Calamaro, Mohua Basu, Nikhil K Chanani, Subhadra Shashidharan, Michael P Fundora","doi":"10.1097/pq9.0000000000000785","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000785","url":null,"abstract":"<p><strong>Introduction: </strong>This project aimed to decrease surgical site wound infections (SSIs) to less than 1 per 100 cases in pediatric patients after cardiothoracic surgery.</p><p><strong>Methods: </strong>A multidisciplinary workgroup was established to identify perioperative risk factors, and educational gaps and create a bedside quality improvement (QI) rounding group to monitor wounds. SSIs were defined according to the Centers for Disease Control National Healthcare Safety Network guidelines. Infection preventionists adjudicated infections as SSIs after an SSI huddle evaluated the case. A QI bundle was developed more than 2 eras: 2015 criteria included an enhanced hygiene bundle, scripted discharge telephone calls about wound care, and 2019 criteria identified SSI risk factors, developed an SSI-QI rounding team, created additional wound care education, and standardized wound care. Data were collected from January 2014 to December 2022 to assess SSI rates per 100 surgical cases, as well as clinically relevant short- and long-term outcomes.</p><p><strong>Results: </strong>From December 2014 to December 2022, there were 5,610 surgical cases evaluated in SSI-QI rounds. Compared with the preintervention cohort, SSI rates decreased significantly during the intervention (SSI per 100 cases 2.82; 95% confidence interval, 1.94-4.09) and postintervention (SSI per 100 cases 0.55; 95% confidence interval, 0.24-1.26). There were no increases in reoperations, postoperative major complications, or discharge mortality throughout the study.</p><p><strong>Conclusions: </strong>SSI rates decreased below the goal of 1 per 100 surgical cases. Standardized wound dressings, improving hygiene compliance including bath compliance from 80% to 96.1%, multidisciplinary collaboration, bedside rounds, and postdischarge procedures contributed to lowering and sustaining low SSI rates.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e785"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960026","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":"Keep Moving: Sustainability of an Early Mobility Protocol in an Academic Pediatric ICU.","authors":"Jenna E Domann, Lindsay E Davies, Elizabeth E Zivick, Laken Johnson, Everette P Keller, Alice A Walz","doi":"10.1097/pq9.0000000000000783","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000783","url":null,"abstract":"<p><strong>Introduction: </strong>Mobilization protocols are safe and feasible for critically ill pediatric patients in the intensive care unit (ICU), but barriers exist to sustainability. This study described a focused early mobility protocol, sustained over 5 years, which is on time for therapy consults and patient mobilization at a single institution.</p><p><strong>Methods: </strong>A formal ICU mobility protocol was implemented as part of a unit-wide ICU liberation bundle. As part of the ongoing program assessment, over a specific 3-month timeframe annually from 2017 to 2023, the number of physical and occupational therapy (PT/OT) consults, mobilization rate, and time to PT/OT consult were analyzed. In addition, in 2023, we assessed specific barriers to early PT/OT consultation.</p><p><strong>Results: </strong>Annually, for each study timeframe, there was a sustained decrease in time to therapy consult from a mean of 3.8 days for PT and 7 days for OT in 2017 to 1.9 and 1.6 days, respectively, in 2023. Similarly, the mobilization rate increased from 20.3 sessions per 100 patient days in 2017 to 48.2 in 2023. There was a trend toward missed or delayed therapy consults at times of higher ICU census. No adverse events were associated with mobilization.</p><p><strong>Conclusions: </strong>An ICU early mobility protocol leads to a sustained decrease in the time to therapy consultation, an increase in the number of therapy consults, and an increase in the mobilization rate. Future interventions should focus on mitigating barriers to timely consultation, specifically at times of higher ICU census.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e783"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960000","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":"Addressing Late-arriving Surgeons in Support of First-case On-time Starts.","authors":"Jonathan B Ida, Jamie H Schechter, John Olmstead, Archana Menon, Mary Beth Iafelice, Amod Sawardekar, Olga Leavitt, Jennifer M Lavin","doi":"10.1097/pq9.0000000000000784","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000784","url":null,"abstract":"<p><strong>Introduction: </strong>First-case on-time starts (FCOTS) is an established metric of perioperative efficiency, impacting global perioperative throughput. Late-arriving surgeons are a common cause of late operating room (OR) starts. This project reflects a quality improvement effort to reduce late surgeon arrivals by 30% for 24 months and improve FCOTS.</p><p><strong>Methods: </strong>A multidisciplinary perioperative leadership team developed clear expectations, including tracking, roles, review processes, and consequences. These were broadly communicated among stakeholders, and feedback was incorporated. A new same-day surgeon-to-surgeon feedback mechanism was instituted for late surgeon arrivals, allowing for surgeon feedback and reiteration of expectations. Results were prospectively tracked for 24 months before and following implementation.</p><p><strong>Results: </strong>Late surgeon arrivals decreased by 45%, from 23.6 to 13 per month for 24 months before and following implementation, respectively (<i>P</i> < 0.001). Balancing measures did not see increases for the same periods. FCOTS increased from 66% to 72% postimplementation (<i>P</i> < 0.001). Statistical process control P-charts demonstrated centerline shifts for both metrics.</p><p><strong>Conclusions: </strong>Development and communication of a clear framework of expectations, review, and consequences, with ongoing monitoring, clear performance expectations, and timely feedback, can reduce late surgeon arrival and improve FCOTS. Direct and timely communication provided immediate feedback to late surgeons and indicated reporting errors, providing more accurate data on late starts. Consistent policy enforcement is critical for credibility.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e784"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959971","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 Antibiotic Use in Argentine Pediatric Hospitals: A Process Evaluation Using Normalization Process Theory.","authors":"Javier Roberti, Facundo Jorro-Barón, Natalí Ini, Marina Guglielmino, Ana Paula Rodríguez, Cecilia Echave, Andrea Falaschi, Viviana E Rodríguez, Ezequiel García-Elorrio, Juan Pedro Alonso","doi":"10.1097/pq9.0000000000000788","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000788","url":null,"abstract":"<p><strong>Introduction: </strong>In the pediatric setting, overprescribing of antibiotics contributes to the rise of multidrug-resistant organisms. Antimicrobial stewardship programs (ASPs) are recommended to optimize antibiotic use and combat resistance. However, the implementation of ASPs in low- and middle-income countries faces several challenges. This study aimed to evaluate the implementation process of a multifaceted ASP in 2 pediatric hospitals in Argentina.</p><p><strong>Methods: </strong>A qualitative study was conducted in two large public children's hospitals in Argentina, using semistructured interviews with 32 healthcare providers at the beginning and end of the ASP implementation. The study was guided by the normalization process theory.</p><p><strong>Results: </strong>The intervention faced challenges, including limited understanding of its objectives, confusion with existing practices, and insufficient commitment from senior staff. Although junior staff were more receptive, communication barriers with external staff and workload concerns hindered broader adoption. Infectious disease specialists primarily led implementation, with limited involvement of other staff, particularly in training activities. Despite these challenges, participants reported improvements, such as the development of standardized antibiotic guidelines, better interdisciplinary collaboration, and improved communication. However, organizational support and resistance to new practices remained barriers.</p><p><strong>Conclusions: </strong>This study highlights the importance of organizational context and staff commitment in ASP implementation. Tailored strategies that address the specific challenges of low- and middle-income countries are needed to effectively implement ASPs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e788"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959996","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":"Transitioning to Opioid-free Anesthesia for Pediatric Supracondylar Fracture Repairs: A Patient Safety Report.","authors":"Laurence O Henson, Jennifer Chiem, Emmanuella Joseph, Fiona Patrao, Daniel King-Wai Low","doi":"10.1097/pq9.0000000000000777","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000777","url":null,"abstract":"<p><strong>Introduction: </strong>Supracondylar fractures are among the most common injuries in the pediatric population. Recently, there has been increased interest in developing opioid-free anesthetic protocols that achieve these same goals without the risks associated with opioid use, such as postoperative nausea and vomiting (PONV), delayed discharges, and respiratory depression.</p><p><strong>Methods: </strong>Seattle Children's Hospital implemented opioid-free anesthesia (OFA) for pediatric supracondylar fracture repairs in January 2021. This patient safety report compares the clinical outcomes of these patients to those who received intraoperative opioids. Clinical effectiveness was measured using the maximum pain scores in the postanesthesia care unit (PACU), postoperative opioid rescue rates in PACU and PONV rescue rate. PACU length of stay (LOS) was chosen as a clinical balancing measure.</p><p><strong>Results: </strong>The opioid group (n = 464) had a mean maximum pain score of 3.39 compared with the OFA group (n = 816), which had a mean maximum of 3.70. The PACU IV opioid rescue rate for the opioid group was 38.82%, whereas the OFA group was 38.73%. The opioid group had a PONV rescue rate of 1.53%, compared with 0.23% in the OFA group. Mean LOS in the PACU was 79 minutes for the opioid group and 86 minutes for the OFA group.</p><p><strong>Conclusions: </strong>The shift to OFA for intraoperative management of patients' supracondylar fracture repair resulted in similar postoperative analgesic outcomes when compared with an opioid-based approach, with a reduced PONV rate and minimal increase in LOS. Transitioning to OFA provided a safe and effective protocol for supracondylar repairs.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e777"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960090","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":"Lessons Learned from a Quality Improvement Initiative to Increase COVID-19 Vaccination in Hospitalized Children.","authors":"Daniel G Young, Cortney S Rogers, Isaac Mayefsky, Thomas Neufeld, Angela Niesen, Patrick J Reich, Carol M Kao, Mythili Srinivasan","doi":"10.1097/pq9.0000000000000782","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000782","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the United States remain lower compared with adults. We aimed to (1) implement a quality improvement initiative to increase COVID-19 vaccination 2-fold in hospitalized patients 12-21 years of age from 4.7% during the baseline period (August 10, 2021-November 1, 2021) to 9.4% during the intervention phase (November 2, 2021-March 31, 2023) and (2) assess the importance of existing interventions and obtain feedback for future interventions to increase COVID-19 vaccination via a provider survey.</p><p><strong>Methods: </strong>We conducted the quality improvement initiative in the inpatient units of a freestanding children's hospital. Interventions included provider education, electronic medical record best practice alerts, monthly competition, parental counseling to increase vaccine acceptance, and ensuring vaccine availability. The primary outcome measure was the percentage of hospitalized patients 12-21 years of age who received COVID-19 vaccine. Providers addressing COVID-19 vaccination with patients, as documented by COVID-19-specific problem lists, were a process measure. Length of stay was a balancing measure.</p><p><strong>Results: </strong>Although COVID-19 vaccination increased 1.6-fold during the initial 5 months of interventions, the interrupted time series analysis did not show a significant impact of our interventions on vaccination. Documentation of COVID-19 vaccine-specific problem lists increased 1.9-fold during most of the intervention period. There was no significant (<i>P</i> = 0.61) difference in length of stay between children in the baseline and intervention groups.</p><p><strong>Conclusions: </strong>Despite our best efforts, we could not increase the number of COVID-19 vaccinations in our patients. Lessons learned suggest that creating a nurse-driven COVID-19 vaccine screening/ordering protocol and integrating COVID-19/influenza vaccination annually during influenza season can potentially increase vaccination rates, but further research is required.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"10 1","pages":"e782"},"PeriodicalIF":1.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960044","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 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}