Pediatric quality & safety最新文献

{"title":"Impact of a Quality Improvement Initiative to Reduce Medication-induced Kidney Injury.","authors":"William Stoudemire, Nour Akil, Adam Bernstein, Erica Bjornstad, Meredith Cuthriell, Nicole D Damari, Darren Dewalt, Carmen Echols, Christopher Falato, Yuting Liao, Ceila Loughlin, Cameron McKinzie, Michael Steiner, Katie Westreich","doi":"10.1097/pq9.0000000000000912","DOIUrl":"10.1097/pq9.0000000000000912","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is a common complication of nephrotoxic medication use in hospitalized children. Prior studies have shown that the use of electronic health record alerts to identify patients exposed to nephrotoxic medications reduced exposure and the incidence of AKI. This initiative aimed to reduce the incidence of AKI by implementing a process to identify nephrotoxic exposures and standardize care for patients receiving nephrotoxic medications.</p><p><strong>Methods: </strong>We used quality improvement methodology to identify and reduce nephrotoxic medication exposure and to standardize hydration and monitoring for patients receiving them. We tested the process on a single hospital service before expanding to other services, with ongoing optimization via monthly Plan-Do-Study-Act cycles.</p><p><strong>Results: </strong>During the 48-month study period, we observed a significant decrease in the mean number of patients exposed to nephrotoxic medications, from a baseline of 11.3 patients per 1,000 patient-days per month to 6.6 patients per 1,000 patient-days per month, a 42% decrease. For patients exposed to nephrotoxic medications, there was an increase in AKI monitoring (via increased creatinine testing) and an increase in the percentage who developed AKI.</p><p><strong>Conclusions: </strong>We adapted and implemented a screening process for exposure to nephrotoxic medications, along with a novel hydration and monitoring pathway. Consistent with previous studies, we observed a dramatic decrease in exposure. An increase in the detection of AKI and a reduction in the proportion of lower risk patients may explain the unexpected increase in the percentage who developed AKI. Our study suggests that implementing standardized identification and monitoring processes can reduce exposure, and that automation and adherence monitoring are important for demonstrating reductions in AKI.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e912"},"PeriodicalIF":1.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898327","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 Guideline-concordant Antibiotic Use for Acute Otitis Media in a Pediatric Primary Care Network.","authors":"Sarah Sweeney, Anna Simon, Laura Morano, Jason Chang, Kari Goebel, Kenisha Campbell, Sheryl A Morelli, Matthew P Kronman","doi":"10.1097/pq9.0000000000000913","DOIUrl":"10.1097/pq9.0000000000000913","url":null,"abstract":"<p><strong>Introduction: </strong>Maintenance of Certification (MOC) projects have previously been shown to improve diagnostic accuracy and infection treatment in inpatient settings.</p><p><strong>Methods: </strong>We developed and delivered an MOC project in our ambulatory care network in 2023 to increase the use of American Academy of Pediatrics guideline-concordant antibiotic selection and duration for the treatment of acute otitis media (AOM), including amoxicillin for most patients, and the use of shorter (5-7 d) antibiotic durations in children over 2 years with nonsevere symptoms. We evaluated the use of guideline-concordant antibiotics across the network from January 2021 to September 2025, including periods before, during, and after the MOC intervention. We compared the use of guideline-concordant antibiotics between clinics that participated in the MOC intervention and those that did not.</p><p><strong>Results: </strong>The study period included 40,329 AOM episodes. By the end of the study period, 64.7% of children with AOM across the network received guideline-concordant antibiotic selection and duration, up from 46.6% at baseline. After the intervention, MOC-participating clinics had increased use of guideline-concordant antibiotic selection and duration compared to nonparticipating clinics (70.1% versus 54.5%). The frequency of patients returning within 7 days for a repeat AOM visit did not differ between the baseline period (124/12,735; 1.0%) and the postintervention period (303/27,594; 1.1%) (<i>P</i> = 0.3).</p><p><strong>Conclusions: </strong>An MOC program was effective in increasing guideline-concordant antibiotic prescriptions for pediatric AOM across an outpatient network. This effect persisted over time and was stronger in MOC-participating clinics. MOC participation has the potential to improve antibiotic stewardship in ambulatory settings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e913"},"PeriodicalIF":1.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898276","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 Referral Adherence in a Developmental/Behavioral Clinic: A Quality Improvement Initiative.","authors":"Sarah E Rysdyk, Jamie L Roberts","doi":"10.1097/pq9.0000000000000853","DOIUrl":"10.1097/pq9.0000000000000853","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple studies have noted significant rates of emotional and developmental concerns in children, coupled with inconsistent rates of engagement with related services. Such inconsistency can lead to a range of negative outcomes. Our project aimed to increase the number of children who completed the intake process following referral to the Child Development Center from 57% to 80% by the end of the second quarter of 2022.</p><p><strong>Methods: </strong>The project team identified barriers to referral adherence and developed targeted interventions to address them. Plan-Do-Study-Act cycles included interventions such as moving the intake process to a phone call, direct outreach to families, enhancing education on Child Development Center services, and increasing communication with referring providers. We used control charts to assess the impact of interventions.</p><p><strong>Results: </strong>Completed intakes increased from 57% to 85% within 2 months and remained between 83% and 89% for the rest of the study. Referral completion rates for children younger than 5 rose from 45% to 75% or higher. The referral completion rate did not vary by ethnicity, race, or insurance type. Although increased referral completion rate led to increased wait times for appointments, 83% of patients who completed an initial intake followed through with an appointment at the Center.</p><p><strong>Conclusions: </strong>We used a quality improvement methodology to increase the percentage of patients who completed an initial intake following referral to the Center. The use of a phone intake option and consistent seeking of feedback and collaboration with all stakeholders involved in the project contributed to its success.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 5","pages":"e853"},"PeriodicalIF":1.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898436","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":"PICU Move! Improving Early Mobilization in a Large Pediatric Intensive Care Unit.","authors":"Jacqueline Zedalis, Katrina Budzynski, Meghan Burkhardt, Amanda Manzi, Susan Phillips, Aubree Little, Riane Goodwin, Vitoria Moreno-Costa, Kumaran Senthil","doi":"10.1097/pq9.0000000000000899","DOIUrl":"10.1097/pq9.0000000000000899","url":null,"abstract":"<p><strong>Introduction: </strong>Guidelines support early mobilization in the pediatric intensive care unit (PICU). In our 75-bed PICU, we implemented \"PICU Move!,\" a standardized early mobilization protocol using \"Critical Care Illness Levels\" (CCILs) that specify mobilization goals based on patients' medical status.</p><p><strong>Methods: </strong>We used systems-based interventions (electronic health record order sets and workflows, opt-out therapy consultations, and progressive mobilization equipment) and person-based interventions (education, mobility champions, simulations, and mobility rounds). Process measures were CCIL ordering compliance, early mobilization goal compliance, and the proportion of admissions with a length of stay (LOS) ≥ 72 hours that included consultations with physical therapy (PT) and occupational therapy (OT). Outcome measures included time to first registered nurse activity documentation (all admissions and admissions with LOS ≥72 h) and admissions with LOS ≥72 hours with multiple PT/OT contacts. Balancing measures included safety event reports related to early mobilization activities, unplanned extubations, and falls.</p><p><strong>Results: </strong>During the intervention period (July 2023-December 2024), median monthly CCIL compliance was 95.9%, and early mobilization goal compliance was 49.4%. Compared to baseline, the average monthly proportion of admissions with LOS ≥72 hours with PT or OT consultation increased from 38.8% to 82.6% and from 34.3% to 81.2%, respectively. Multiple PT and OT contacts increased from 40.9% to 81.7% and from 37.7% to 70.8%, respectively. Time to first activity decreased from 21.6 to 19.6 hours (all admissions) and from 67.9 to 59.1 hours (admissions with LOS ≥72 h). There were no documented safety events related to early mobilization activities.</p><p><strong>Conclusions: </strong>In a large PICU, systems-based interventions, supplemented by person-based interventions, safely reduced time to first activity and increased the number of repeated PT/OT contacts.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e899"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633169","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":"Newborn Falls and the Need for Innovative Solutions.","authors":"Colleen A Hughes Driscoll, Mary Divya Kasu","doi":"10.1097/pq9.0000000000000881","DOIUrl":"10.1097/pq9.0000000000000881","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e881"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633140","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 Project to Reduce Wait Time for Pediatric Gastrointestinal Procedures.","authors":"Jennifer M Colombo, Nicholas A Clark, Laura E Shroyer, Dustin J Hahn, Jonathan Patterson, Kenneth J Sam","doi":"10.1097/pq9.0000000000000900","DOIUrl":"10.1097/pq9.0000000000000900","url":null,"abstract":"<p><strong>Introduction: </strong>Delays in care can lead to poor health outcomes and suboptimal patient and family experiences. We aimed to reduce the average wait time for gastrointestinal endoscopic procedures (procedure request to procedure completion) from 145 to 15 days (a 90% reduction) within 4 months (November 2023 to March 2024).</p><p><strong>Methods: </strong>A3 problem-solving methodology was used. The primary intervention was a multiday, multidisciplinary improvement workshop. Outcome measures included (1) procedure request date to procedure completion date, and (2) favorable patient satisfaction score for timeliness of access to care. Process measures included (1) procedure request date to date procedure scheduled by staff, and (2) date procedure scheduled by staff to procedure completion date. The balancing measure was the number of procedures scheduled per weekday. Control charts assessed the impact of interventions.</p><p><strong>Results: </strong>Following the primary intervention (October 2023), special cause improvement was seen for all but the balancing measure. Outcome measure 1 achieved a sustained reduction in mean monthly wait time from 145 to 26.4 days (an 82% reduction), whereas outcome measure 2 achieved sustained improvement in patient satisfaction from 39.7% to 50.2% (a 26.4% relative improvement). Process measures 1 and 2 had sustained reductions from 56.5 to 14.7 days (a 74% reduction) and 89.1 to 20.7 days (a 77% reduction), respectively. The balancing measure also remained unchanged at a monthly average of 11.7 procedures scheduled per weekday.</p><p><strong>Conclusions: </strong>Using A3 problem-solving methodology, we achieved an 82% sustained reduction in endoscopic procedure wait times with a concurrent 26.4% improvement in patient satisfaction. Procedures are now routinely completed within 1 month of the request date.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e900"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633166","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":"Maximizing Efficiency: A Quality Improvement Project to Improve Inpatient Flow to the Operating Room.","authors":"Amber M Franz, Christina M Street, Colin D Crook, Pamela L Christensen, Eno Chen, Rosemary E Walkup, Elena J Raney, Lauren A Burnett, Lizabeth D Martin","doi":"10.1097/pq9.0000000000000904","DOIUrl":"10.1097/pq9.0000000000000904","url":null,"abstract":"<p><strong>Introduction: </strong>Half a million pediatric inpatients undergo surgery each year. At a large, tertiary-care academic pediatric hospital, the time required to transition inpatients from the acute care units to the preoperative zones was lengthy and unreliable, resulting in costly operating room (OR) delays.</p><p><strong>Methods: </strong>In 2024, the perioperative microsystem quality improvement team aimed to improve preoperative efficiency by 10% for nonintensive care unit inpatients undergoing nonemergent surgery in the main hospital ORs. The primary outcome measure was the time from the OR's phone call for the inpatient to completion of preoperative nursing tasks, as documented in the electronic health record. The Institute for Healthcare Improvement model framework guided the work. Multiple Plan-Do-Study-Act cycles aimed to improve communication among acute care unit, OR, and preoperative staff. Data were displayed as statistical process control charts.</p><p><strong>Results: </strong>Mean time from calling for the inpatient to preoperative task completion improved from 48.2 minutes at baseline to 43.7 minutes (4.5 min, 9.3% improvement), with a sustained downward shift of the centerline on statistical process control analysis. After the second intervention, process variability also decreased relative to baseline and persisted after implementation.</p><p><strong>Conclusions: </strong>Multiple Plan-Do-Study-Act cycles focused on inpatient-to-OR readiness led to more than 9% improvement in patient flow, enhanced communication between groups, increased awareness of preoperative preparation tasks, and improved trust in OR readiness signals to the preoperative zones. Further study is needed to determine whether similar interventions would be effective at improving efficiency at other hospitals.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e904"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633145","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":"An Initiative to Prevent Newborn Drops through the Implementation of a Prevention Bundle at a Children's Hospital.","authors":"Holly M Birkinshaw, Ashley R Owens, Aries C Gilchrist, Jennifer Barrows, Jennifer Lusk","doi":"10.1097/pq9.0000000000000836","DOIUrl":"10.1097/pq9.0000000000000836","url":null,"abstract":"<p><strong>Introduction: </strong>Newborn drops are a problem in hospitals across the United States. This type of fall, characterized by an infant slipping from the arms or lap of a parent or caregiver, can have severe consequences and result in emotional distress for families. The lack of a comprehensive approach to preventing newborn drops at our children's hospital highlighted an urgent need for action. Although existing research has focused on maternal-child acute care units, a notable gap remains in evidence-based solutions for children's hospitals. We developed a baby drop prevention bundle to address this problem.</p><p><strong>Methods: </strong>We used improvement science to implement and evaluate the bundle across the hospital. A Plan-Do-Study-Act model guided iterative cycles of improvement. The bundle included staff and caregiver education, frequent intentional safety rounding for newborns aged 30 days or younger, an infant fall risk assessment, a supportive pillow for newborn holding and feeding, protected maternal rest periods, and standardized reporting and debriefing of infant drops and near misses. The primary outcome measure was the incidence of newborn drops; the process measure was compliance with the bundle, and an additional measure was near-miss events.</p><p><strong>Results: </strong>Since implementing the baby drop prevention bundle, there have been 0 incidents of newborn drops. We have observed 10 near-miss events since May 2025. Compliance reached 100% with the rounding plan and 90% with the use of the supportive pillow during 10 months.</p><p><strong>Conclusions: </strong>A baby drop prevention bundle likely reduced the risk of newborn drops and promoted a culture of safe sleep at a children's hospital.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e836"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633171","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 Pediatric Emergency Department Lethal Means Safety Documentation Rates for Adolescents with Mental Health Concerns.","authors":"Cassandra L Stegall, Ana-Maria McGill, John Fanton, Paul C Mullan","doi":"10.1097/pq9.0000000000000903","DOIUrl":"10.1097/pq9.0000000000000903","url":null,"abstract":"<p><strong>Introduction: </strong>Lethal means safety counseling (LMSC) is recommended for children presenting to the emergency department (ED) for a mental health (MH) evaluation. Currently, no gold-standard guidelines exist for documenting LMSC in the ED.</p><p><strong>Methods: </strong>This quality improvement project was conducted in the ED of a tertiary children's hospital. Baseline data were analyzed for access to any LMSC documentation (ALD) for \"firearms/guns,\" \"sharps,\" or \"medication,\" and for complete LMSC documentation (CLD) if access to all 3 types was documented. The first intervention period added open-ended screening questions about access to lethal means to the MH-licensed clinical social worker note template. Intervention period 2 implemented an electronic health record \"PowerForm\" in Cerner PowerChart. We aimed to increase ALD and CLD to exceed 75% and 50%, respectively, during a 6-month period, with sustained success. Statistical process control p-charts with standardized special-cause rules were used to determine performance over time.</p><p><strong>Results: </strong>Baseline ALD and CLD rates were 3% and 1%, respectively. During intervention 1, the ALD and CLD rates increased to 81% and 68%, respectively, with special-cause variation noted for both rates. During intervention 2, ALD increased to 90%, but CLD rates did not change significantly (66%). For intervention 2, the documentation of firearm/gun access (90%) was higher than documentation of access to sharps (68%) or medication (69%).</p><p><strong>Conclusions: </strong>We achieved a significant increase in ALD and CLD for MH evaluations in our ED. Lessons learned may generalize to other ED settings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e903"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633097","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":"Systematizing and Optimizing Collection of Patient-reported Outcomes after Community-based Care: A Quality Improvement Project.","authors":"Julianna Berardi, Hillary M Kapa, Zijing Liu, Talia Morikawa, Rachel K Myers","doi":"10.1097/pq9.0000000000000893","DOIUrl":"10.1097/pq9.0000000000000893","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare systems routinely assess patients' perspectives on inpatient and outpatient care. Still, patients cared for outside of these clinical settings have limited opportunities to share experiences and provide feedback. Current data collection strategies may also under-capture feedback from marginalized or hard-to-reach populations, potentially reinforcing existing inequities in care. This project aimed to (1) systematize the collection of feedback from participants in a pediatric hospital-based violence intervention program (HVIP) providing community-based case management services following violence-related injury and (2) optimize collection methodology to achieve and maintain a quarterly response completion rate of 50%.</p><p><strong>Methods: </strong>Collection of the HVIP Client Satisfaction Questionnaire (HVIP-CSQ), a brief survey assessing satisfaction with and perceived short-term outcomes of HVIP participation, began in July 2021. Caregivers and patients self-completed surveys electronically in response to text message or email invitations. In March 2023, a rapid-cycle quality improvement initiative was initiated to optimize response rates. Using an expanded data collection methodology, an outreach coordinator invited nonrespondents to complete surveys via phone and text message.</p><p><strong>Results: </strong>During the initial HVIP-CSQ data collection, quarterly response rates were suboptimal. On average, 29.5% of caregivers and 23.5% of patients completed the HVIP-CSQ. Following improvements to the collection methodology, average quarterly response percentages exceeded the set targets, reaching 78.4% for caregivers and 51.8% for patients.</p><p><strong>Conclusions: </strong>Multimodal outreach strategies improved response rates for patients and caregivers. Although automated and self-directed survey methods offer advantages in reach and efficiency, they may not sufficiently engage respondents. Flexible, multimodal feedback systems can enhance data completeness and support more inclusive quality improvement efforts.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e893"},"PeriodicalIF":1.2,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633095","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}