Pediatric quality & safety最新文献

{"title":"How Super Is Supertrack? Expediting Care of Fast-track Patients through a Pediatric Emergency Department.","authors":"Daniel Lam, Cortney Braund, Sarah Schmidt, Bernadette Johnson, Sandra P Spencer, Chisom Agbim","doi":"10.1097/pq9.0000000000000770","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000770","url":null,"abstract":"<p><strong>Background: </strong>Fast-track models decrease patient crowding in emergency departments (EDs) by redirecting low-acuity patients to an expedited care pathway. In 2016, this institution's pediatric ED created a fast-track pathway for patients evaluated in a rapid assessment triage area who needed further management in the primary ED. This \"Supertrack\" designation was intended for patients requiring up to 1 hour of additional care, though means of ensuring these patients were discharged within their anticipated timeframe were lacking.</p><p><strong>Methods: </strong>We aimed to increase the percentage of Supertrack patients discharged within 1 hour of their ED bed assignment from 17% to 50%. Interventions included the creation of objective Supertrack criteria, departmental-wide progress reports, personalized reminders, intake huddles, and documentation prompts. We visualized data from Plan, Do, Study, Act (PDSA) cycles with statistical process control charts to determine special cause variation.</p><p><strong>Results: </strong>The percentage of Supertrack patients discharged within their anticipated timeframe increased from 17% to 27% without an increase in return ED visits. The average time Supertrack patients spent in the ED decreased from 121 to 103 minutes. Personalized reminders demonstrated a significant but short-lived improvement.</p><p><strong>Conclusions: </strong>We improved the flow of Supertrack patients by decreasing their length of stay and increasing how many were discharged within their anticipated timeframe. Limitations included an unexpected surge in patients with respiratory complaints and staffing and structural constraints preventing the designation of a discrete Supertrack assessment space with dedicated providers. These findings are helpful for institutions seeking to develop an effective fast-track model with limited space and resources.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e770"},"PeriodicalIF":1.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302889","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":"Integrating Emotional Health Assessments into Pediatric Care: Initial Learnings from an MOC Part 4 Activity.","authors":"Carole M Lannon, Christine L Schuler, LaCrecia Thomas, Emily Gehring, Keith J Mann, Laurel K Leslie","doi":"10.1097/pq9.0000000000000768","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000768","url":null,"abstract":"<p><strong>Introduction: </strong>Living with a chronic condition often impacts the emotional health of children. Pediatricians frequently feel unprepared to address these concerns. The American Board of Pediatrics Roadmap Project aims to support these clinicians. We describe the results from the initial cohort of pediatricians who completed the American Board of Pediatrics Maintenance of Certification (MOC) Roadmap Part 4 activity.</p><p><strong>Methods: </strong>The Roadmap MOC activity uses a standardized improvement template with accompanying resources to guide participants. Physicians self-assess their ability to provide emotional health support by completing a Roadmap Readiness Checklist and creating a personal project relevant to their practice. They collect data at three time points: baseline, midpoint, and completion for two measures (the Readiness Checklist and a participant-selected measure). Physicians also reflect on their experience.</p><p><strong>Results: </strong>Of the initial cohort of 29 physicians, 22 submitted three sequential checklist assessments. Scores increased for \"developing a family resource list\" (by 90%), \"confidence to address emotional health\" (79%), \"having a family crisis plan\" (78%), and \"staff awareness\" (34%). Twenty-four physicians who measured whether clinical encounters addressed emotional health documented an increase from 21% to 77%. Physician feedback was positive, for example, \"This project has had a profound impact on our care of children.\"</p><p><strong>Conclusions: </strong>This initial cohort of participants improved on the Readiness Checklist and emotional health assessment. Both generalist and subspecialty pediatricians found the activity useful and relevant, suggesting that this MOC Part 4 activity is a feasible resource for supporting physicians in addressing emotional health.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e768"},"PeriodicalIF":1.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302890","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":"Focused Team Engagements to Enhance Interprofessional Collaboration and Safety Behaviors among Novice Nurses and Medical Residents.","authors":"Rosalyn Manuel, Aisha Barber, Jeremy Kern, Kristi Myers, Tara Neary, Laura Nicholson, Heather Walsh, Pavan Zaveri, Pallavi Dwivedi, Claire Maggiotto, Simmy King","doi":"10.1097/pq9.0000000000000767","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000767","url":null,"abstract":"<p><strong>Background: </strong>Team communication remains a challenge in hospital settings. Hospital-based teams are diverse, team composition changes daily, and team members are frequently not co-located. Novice nurses and medical residents entering the workforce during the coronavirus 2019 pandemic experienced higher communication challenges than before and lacked adequate opportunities for interprofessional learning and communication.</p><p><strong>Method: </strong>We evaluated perceptions of safety and communication among novice nurses and medical residents after a 1-hour focused team engagement consisting of an interprofessional virtual simulation and debrief. We conducted a retrospective pre/post survey to measure perceptions of interprofessional collaboration using the Interprofessional Socialization and Valuing Scale.</p><p><strong>Results: </strong>Sixty-eight pediatric nurse residents and medical residents participated in the survey. Overall, the focused team engagements significantly improve participants' perceptions of interprofessional collaboration, with participants showing statistically significant improvement in seven of nine retrospective pre/post survey questions. When analyzing by discipline, nurse residents show stronger gains than medical residents.</p><p><strong>Conclusions: </strong>The interprofessional structured debriefings encourage nurses and medical residents to collaborate and discuss important safety topics away from bedside stressors. After completing the virtual simulation, the outcomes show improved perceptions of interprofessional collaboration and enhanced knowledge of safety techniques.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e767"},"PeriodicalIF":1.2,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302888","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":"Sustainability of a PICU Situation Awareness Intervention: A Qualitative Study.","authors":"Maya Dewan, Jonelle Prideaux, Daniel Loeb, Ruchit V Patel, Matthew Zackoff, Sapna R Kudchadkar, Lisa M Vaughn, Amanda C Schondelmeyer","doi":"10.1097/pq9.0000000000000757","DOIUrl":"10.1097/pq9.0000000000000757","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate facilitators and barriers that impact the sustainability of an interprofessional situation awareness bundle.</p><p><strong>Methods: </strong>This is a single-center qualitative study at a tertiary care pediatric center examining the sustainability of an interprofessional situation awareness bundle to reduce in-hospital cardiac arrests. The bundle includes an automated clinical decision support tool, twice-daily safety huddles, and a bedside mitigation plan. A trained research staff member interviewed participants in October 2022. Interviews were audio recorded and transcribed verbatim, and recruitment continued until data saturation. Inductive and deductive analyses were used here.</p><p><strong>Results: </strong>The authors interviewed twelve staff members via individual semistructured interviews: registered nurses (RN, n = 2) and clinicians [(advanced practice providers, n = 2), pediatric critical care fellows, n = 4 and attendings, n = 4)]. Five main themes were identified: (1) the situation awareness bundle is <i>ingrained</i> into daily practice and culture, (2) the bundle has <i>strengthened</i> communication, decision-making, and improved outcomes, (3) standardized processes, stakeholder buy-in, and support of team members are key to adoption and <i>sustainability</i>, (4) variation in processes and fast-changing clinical context remains a <i>challenge</i> for reliable use, and (5) the situation awareness bundle <i>excluded</i> families.</p><p><strong>Conclusions: </strong>The situation awareness bundle has become ingrained, strengthened, and sustained over the last 5 years through integration into daily practice and culture and leveraging standardized processes, tools and technology. It is associated with improved communication and shared decision-making. Understanding the key components for implementation and sustainability is necessary for ongoing spread and improvement in the future.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e757"},"PeriodicalIF":1.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127498","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 Falls in Hospitalized Children and Adolescents with Cancer and Blood Disorders: A Quality Improvement Journey.","authors":"Lisa K Morrissey, Phuc Ho, Maya Ilowite, David A Johnson, Colleen M Nixon, Marissa K Thomas, Julie A Waitt, Amy Wierzchowski, Ashley M Renaud","doi":"10.1097/pq9.0000000000000755","DOIUrl":"10.1097/pq9.0000000000000755","url":null,"abstract":"<p><strong>Background: </strong>Falls in hospitalized pediatric patients represent a serious patient safety concern. Children and adolescents with cancer and blood disorders have inherent risk factors that increase the likelihood of injury from falls. The Hematology/Oncology (HO) and Stem Cell Transplant (SCT) inpatient units at Boston Children's Hospital embarked on a multiyear quality improvement journey to reduce inpatient falls in this population.</p><p><strong>Methods: </strong>A targeted Falls Reduction Task Force implemented key initiatives between 2020 and 2023. These include enhancing communication strategies to heighten awareness of the highest fall-risk patients, conducting a formal apparent cause analysis on every fall with injury, and initiating a physical therapy-led program to reduce deconditioning. Outcome measures were total falls, rate of preventable falls with injury per 1000 patient days, and days between preventable falls with injury. Our quality improvement team used statistical process control charts to track changes over time.</p><p><strong>Results: </strong>The combined rate of preventable falls with injury per 1000 patient days decreased from 0.63 in fiscal year (FY) 2020 to 0.25 in 2023. The SCT and HO units achieved a maximum of 442 days and 410 days, respectively, between preventable falls with injury in 2021-2023, compared with 124 and 117 days in 2020. The two units observed a 51% reduction in total falls over 4 years.</p><p><strong>Conclusions: </strong>A multifaceted fall reduction quality initiative effectively reduced preventable falls with injury on pediatric HO and SCT inpatient units, thereby reducing avoidable harm in a vulnerable patient population.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e755"},"PeriodicalIF":1.2,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115732","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 Project to Decrease Fractures Secondary to Metabolic Bone Disease of Prematurity.","authors":"Nicole M Rau, Lisa J Monagle, Ashley M Fischer","doi":"10.1097/pq9.0000000000000750","DOIUrl":"10.1097/pq9.0000000000000750","url":null,"abstract":"<p><strong>Introduction: </strong>Osteopenia of prematurity is common in the neonatal intensive care unit, with an incidence of up to 54% in extremely low birthweight infants. The baseline fracture rate in our level IV midwestern neonatal intensive care unit was 13%, with poor compliance with recommended intakes of calcium, calcium:phosphorus ratio, and Vitamin D.</p><p><strong>Methods: </strong>A multidisciplinary team implemented a screening guideline through four Plan-Do-Study-Act cycles, which addressed staff education, vitamin D screening, and incorporation of calcitriol. In total, 150 patients born between October 1, 2019 and April 30, 2023 were screened for mineral intakes, laboratory abnormalities, and the development of fractures or osteopenia.</p><p><strong>Results: </strong>The incidence of fractures decreased from 13% to 5.3%. Compliance with mineral intakes improved for calcium, calcium: phosphorus ratio, and Vitamin D. Infants born after the guideline were 4.8 times less likely to develop fractures.</p><p><strong>Conclusion: </strong>Quality improvement methodology successfully decreased the rate of fractures due to osteopenia of prematurity and increased compliance with recommended mineral intakes.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 4","pages":"e750"},"PeriodicalIF":1.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11286248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794227","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 Emergency Department Quality Improvement Project to Decrease Lumbar Puncture Rates in Febrile Infants 22 to 28 Days Old.","authors":"Jessica M Kelly, Brandon C Ku, Payal Gala, Bobbie Hawkins, Brian Lee, Salvatore Corso, Rebecca Green, Richard Scarfone, Jane M Lavelle, Emily R Kane, Laura F Sartori","doi":"10.1097/pq9.0000000000000749","DOIUrl":"10.1097/pq9.0000000000000749","url":null,"abstract":"<p><strong>Introduction: </strong>Most providers have routinely performed universal lumbar puncture (LP) on well-appearing, febrile infants 22 to 28 days old. In 2021, the American Academy of Pediatrics recommended clinicians should perform an LP in this age group if inflammatory markers are abnormal. This quality improvement project aimed to decrease LP rates in febrile infants 22 to 28 days old in the emergency department (ED) within 1 year, regardless of race/ethnicity, from a baseline of 87%.</p><p><strong>Methods: </strong>We used our institution's quality improvement framework to perform multiple Plan-Do-Study-Act cycles. A multidisciplinary team reviewed the febrile infant literature, local epidemiology, and identified key drivers. We provided departmental education, updated our clinical pathway, and used clinical decision support. We analyzed baseline (January 2017-March 2022) and intervention data (April 2022-March 2024) and tracked data using statistical process control charts. Our primary outcome measure was rates of LP in the ED for this cohort. Process measures included rates of infants with procalcitonin results. ED length of stay, rates of first LP attempt after hospitalization, and missed bacterial meningitis were balancing measures.</p><p><strong>Results: </strong>The baseline LP rate of 87% decreased to 44% during the intervention period, resulting in a downward centerline shift. There were no significant differences when LP rates were analyzed by race/ethnicity. There was an upward centerline shift in the process measure of infants with procalcitonin results. There was no observed special cause variation in our balancing measures.</p><p><strong>Conclusion: </strong>Quality improvement efforts, including education, clinical pathway updates, and clinical decision support, safely reduced rates of LPs in febrile infants 22 to 28 days old.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 4","pages":"e749"},"PeriodicalIF":1.2,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735925","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 Safety through a Virtual Learning Collaborative.","authors":"Jeffrey P Durney, Katie M Catalano, D Marlowe Miller, Amy J Starmer, Kate Humphrey, Catherine Perron, Anne M Stack","doi":"10.1097/pq9.0000000000000740","DOIUrl":"10.1097/pq9.0000000000000740","url":null,"abstract":"<p><strong>Background: </strong>Frontline healthcare safety leaders require expertise and confidence to manage local safety programs effectively yet are confronted with substantial challenges in identifying risk and reducing harm.</p><p><strong>Methods: </strong>We convened a multidisciplinary safety learning collaborative in a children's hospital pediatric department and used the Institute for Healthcare Improvement's Breakthrough Series model. Participants attended four virtual education sessions over 13 months (September 2020-September 2021) focused on identifying harm and using tools to improve safety. We analyzed departmental safety data monthly throughout the collaborative. The primary outcome was the development of improvement projects using direct application of the session content. The secondary outcome was participant confidence in improving safety via pre- and postsurveys.</p><p><strong>Results: </strong>Seventy clinicians and quality consultants participated. Fifteen divisional safety improvement projects were initiated. The percentage of survey respondents who reported feeling \"completely confident\" in their ability to improve safety increased from 26% (n = 39) to 58% (n = 26) from September 2020 to September 2021 (<i>P</i> = 0.01) and maintained at 65% 1 year after the end of the collaborative. We observed a decrease in the mean rate of reported inpatient preventable and possibly preventable moderate/serious/catastrophic events per 1000 bedded days from 1.10 (baseline) to 0.71 (intervention period).</p><p><strong>Conclusions: </strong>Through a collaborative effort in a virtual learning environment, we facilitated the development of fifteen safety projects, increased leaders' confidence in improving safety, and saw improved inpatient safety. This approach, which involves healthcare professionals from various disciplines, may be effectively adapted to other settings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 4","pages":"e740"},"PeriodicalIF":1.2,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735926","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":"Combating Disparities in a Pandemic: Increasing Dissemination of Coronavirus Disease 2019 Resources in Spanish.","authors":"Romina L Barral, Nicholas A Clark, Fernando Zapata, Lines M Vargas Collado, July Jean Cuevas, Cristina Fernandez","doi":"10.1097/pq9.0000000000000744","DOIUrl":"10.1097/pq9.0000000000000744","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities exist in access to coronavirus disease 2019 (COVID-19)-related health information. We aimed to close a gap in online traffic between English and Spanish COVID-19-related health information on our institution's publicly-facing website by 50% within ten months.</p><p><strong>Methods: </strong>We used A3 improvement methodology. Outcome measures were the mean monthly difference between English and Spanish COVID-19 online traffic vis-a-vis (1) total webpage views and (2) unique webpage visits. Process measures were stratification of outcome measures by language. Plan-Do-Study-Act cycles included: Recurring advertisements on a local Spanish television station disseminating up-to-date COVID-19 information, including our institution's Spanish COVID-19 online resources, incorporation of QR codes into clinic discharge paperwork linking to institutional Spanish COVID-19 resources, and leveraging social media to expand reach. Control charts assessed impact over time.</p><p><strong>Results: </strong>There were 1,226,196 total webpage views (369,983 Spanish; 856,213 English) and 1,065,536 unique webpage visits (350,518 Spanish; 715,018 English). Both outcome measures displayed sustained, special cause improvement from a mean monthly difference of 25,397 to 11,321 webpage views (55.4% reduction, June 2021) and 25,066 to 7080 unique webpage visits (71.8% reduction, February 2021) corresponding to special cause improvements in process measures. Improvements were not temporally associated with an intervention but coincided with emergency use approval of the COVID-19 vaccine for children aged 12-15 years (May 2021).</p><p><strong>Conclusions: </strong>Although our interventions did not directly show improvements in our measures, we noted increased page views of Spanish COVID-19-related health information on our institution's publicly-facing website in times of high demand for linguistically appropriate services, including pediatric vaccine roll-out.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 4","pages":"e744"},"PeriodicalIF":1.2,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592301","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 Interpreter Access in the Pediatric Emergency Department: A Quality Improvement Initiative.","authors":"Katherine E Douglas, Miriam T Fox, Christine C Cheston, M Laxmi Behara, Kyle A Schoppel","doi":"10.1097/pq9.0000000000000748","DOIUrl":"10.1097/pq9.0000000000000748","url":null,"abstract":"<p><strong>Background: </strong>An increasing proportion of the population in the United States have limited English proficiency (LEP). Hospitals that receive federal funding must offer interpreter services. However, access is often lacking for patients. Patients with LEP are at higher risk for adverse events, and the Emergency Department is a particularly high-risk environment for these events.</p><p><strong>Methods: </strong>This quality improvement initiative took place from April 2021 to August 2022 in an urban, tertiary care Pediatric Emergency Department. A driver diagram informed four Plan-Do-Study-Act cycles, and data were collected through medical record review, patient surveys, and staff surveys. We tracked outcomes using run and control chart data.</p><p><strong>Results: </strong>During the study period, the proportion of patients with LEP reporting \"always\" having an interpreter was unchanged (no centerline shift-control chart rules). Documentation of interpreter use for encounters with patients with LEP improved. Preferred language documentation and documentation of the need for an interpreter in the electronic medical record showed no change. Process measure data for staff-reported use of professional interpreters significantly increased, and the use of ad hoc interpreters decreased significantly. Length of stay did not change for English or LEP patients.</p><p><strong>Conclusions: </strong>This quality improvement initiative improved appropriate documentation of LEP and decreased use of nonqualified interpreters, although no change occurred in the proportion of patients who reported always having an interpreter. Patient satisfaction was unaffected.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 4","pages":"e748"},"PeriodicalIF":1.2,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592302","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}