Pediatric quality & safety最新文献

{"title":"Quality Improvement Initiative to Reduce Inappropriate Viral Testing within the Pediatric Emergency Department.","authors":"Cherisse Mecham, Rachel Kortman, Emma Albrecht, Sam Dowell, Cecilia Monteilh","doi":"10.1097/pq9.0000000000000898","DOIUrl":"10.1097/pq9.0000000000000898","url":null,"abstract":"<p><strong>Introduction: </strong>The American Academy of Pediatrics Section on Emergency Medicine's Choosing Wisely Campaign includes recommendations discouraging comprehensive viral panel testing in children with suspected respiratory viral illness. In the year preceding project implementation, our free-standing pediatric emergency department (PED) ordered comprehensive respiratory pathogen panels (RPPs) in 11.9% of all visits, and 50% of those lacked a clinical indication. This project aimed to reduce the percentage of PED visits with RPP orders from 11.9% to 9% over a 6-month viral respiratory season.</p><p><strong>Methods: </strong>We conducted four major interventions over 2 plan-do-study-act cycles. Interventions included developing a clinical guideline for viral testing, performing provider education, introducing a narrower-spectrum Quad (influenza A/B, COVID-19, and respiratory syncytial virus) polymerase chain reaction (PCR) test, and adding an order-entry indication requirement for RPPs, which also served as a just-in-time educational tool for providers. We tracked data via a clinical dashboard and through periodic chart reviews.</p><p><strong>Results: </strong>Of the 43,283 patient visits during the project period, the percentage of PED RPP orders decreased from 11.9% at baseline to 6.8% during the intervention period and remained at 6.8% in the following respiratory season. The project had sustained cost savings of over $300,000 in RPP testing each year. The decrease in RPP orders did not lead to an increase in the cumulative use of other viral tests.</p><p><strong>Conclusions: </strong>This quality improvement initiative significantly improved and sustained comprehensive viral PCR testing practices in the PED without increasing the use of alternative respiratory viral testing.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e898"},"PeriodicalIF":1.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474601","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":"Empowering Caregivers, Protecting Patients: An Ambulatory Central Line Quality Improvement Initiative for Education and Follow-up.","authors":"Elizabeth Martinez, Belinda Bordeaux, Stephanie Langevin, Cristina Herrera, Mary Smith, Merissa Doyle, Barbara Stein, Kimberly Poshar, Marissa Dunlap, Allison Silva, Eric Werner","doi":"10.1097/pq9.0000000000000885","DOIUrl":"10.1097/pq9.0000000000000885","url":null,"abstract":"<p><strong>Introduction: </strong>Preventing ambulatory central line-associated bloodstream infections (A-CLABSIs) is challenging due to inconsistent education, follow-up, and home care practices. Pediatric intestinal failure (IF) patients are particularly vulnerable. This institution aimed to decrease its IF A-CLABSI rate by 25% within 2 years through a standardized, step-by-step central line care education program.</p><p><strong>Methods: </strong>Using the Toyota problem-solving method, the team reviewed data and performed a root cause analysis of the prioritized problem, implementing a 2-phase education program. Phase 1 delivered in-hospital education using videos, handouts, and hands-on teaching with skill demonstration. The existing pediatric central line skills class was expanded and offered to partnering home health agencies. Phase 2 included postdischarge follow-up via phone calls or clinic visits to address questions and identify needs. Family feedback was collected through surveys.</p><p><strong>Results: </strong>The average IF A-CLABSI rate decreased from 3.66 per 1,000 ambulatory line days to 1.85, representing a 49.5% reduction (<i>P</i> = 0.1479). One hundred percent of families surveyed at 7 days postdischarge reported confidence in providing central line care at home and found follow-up phone calls very helpful. Among 44 home health staff trained, the mean percent improvement in pre- to posttest scores was 47%. Families and home health personnel especially valued the hands-on learning component.</p><p><strong>Conclusions: </strong>The standardized education program substantially reduced the rate of IF A-CLABSIs and improved confidence and satisfaction among families and home health nurses. It also enhanced collaboration among families, home health agencies, and the health system, fostering trust and continuity of care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 4","pages":"e885"},"PeriodicalIF":1.2,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474588","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":"Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department.","authors":"Jonathan A Hermel, Yvette Wang, Jamie M Klapp, Amy Bryl, Martha Pannepacker, Elise Zimmerman","doi":"10.1097/pq9.0000000000000891","DOIUrl":"10.1097/pq9.0000000000000891","url":null,"abstract":"<p><strong>Introduction: </strong>Multidisciplinary clinical debriefs are structured discussions following critical events to assess performance, identify improvement opportunities, and provide team support. Despite known benefits, debriefs are underused. We aimed to increase debrief completion following pediatric emergency department (ED) cardiac arrests and endotracheal intubations. The primary outcome was the percentage of critical events with a completed debrief form. To assess potential workflow disruptions, we assessed 2 balancing measures: room-to-provider and door-to-provider times among Emergency Severity Index level 1 and 2 patients.</p><p><strong>Methods: </strong>A key driver diagram guided targeted interventions. We implemented a standardized Research Electronic Data Capture (REDCap) debrief form using a plus-delta framework with scripted prompts, accessible via quick response codes throughout the ED. As part of the intervention design, debriefs were encouraged within 30 minutes of the event and were designed to last 7 minutes or less. Educational initiatives included staff meetings, email reminders, newsletters, signage, and designated nursing champions. We used statistical process control to assess changes over time.</p><p><strong>Results: </strong>Debrief completion increased from 4% to 52% during 15 months, showing special-cause variation. Median room-to-provider times remained unchanged. Median door-to-provider times decreased during the intervention period.</p><p><strong>Conclusions: </strong>Multiple interventions significantly increased the use of structured debriefing without adversely affecting patient flow. Structured debriefing is both feasible and sustainable in high-acuity ED settings, particularly when supported by ongoing education and active team engagement.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e891"},"PeriodicalIF":1.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201442","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":"Diagnostic Stewardship to Optimize Blood Culture in a Pediatric Cardiac Intensive Care Unit.","authors":"Jun Sasaki, Angela Sorensen, Kristen Ferlisi, Lauren Shaw, Maryellen Horgan, Catherine Mareiro, Sarah A Teele","doi":"10.1097/pq9.0000000000000887","DOIUrl":"10.1097/pq9.0000000000000887","url":null,"abstract":"<p><strong>Introduction: </strong>The threshold for ordering blood cultures and initiating empiric broad-spectrum antibiotic therapy is often low in pediatric cardiac intensive care units (CICUs). However, excessive blood cultures carry risks, including anemia, false-positive results, and contamination related to vascular access. Overuse of broad-spectrum antibiotics can lead to the development of multidrug-resistant bacteria.</p><p><strong>Methods: </strong>In this quality improvement initiative focused on diagnostic stewardship, a blood culture algorithm was developed to reduce unnecessary blood culture sampling in patients with low sepsis probability. All patients admitted to the CICU were included in the study. The preimplementation observation period spanned from January 2022 to June 2023, and the postimplementation observation period lasted from July 2023 to December 2025.</p><p><strong>Results: </strong>There were 5,958 CICU admissions during the study period, with no statistically significant difference in the baseline clinical characteristics. The number of blood culture samples declined by 26% in the postimplementation period, from 111.9 to 82.8 per 1,000 patient-days (<i>P</i> < 0.001), and a centerline shift was observed after the 5-month mark in the statistical process control U-chart. No statistically significant change was observed in the central line-associated bloodstream infection rate per 1,000 line-days (1.7 versus 1.3, <i>P</i> = 0.26).</p><p><strong>Conclusions: </strong>A structured algorithm to support clinicians' decision-making for blood culture testing resulted in a statistically significant reduction in the number of blood cultures sent. The delayed centerline shift indicated that lasting change required complete practice adoption rather than mere intervention launch. This intervention was not associated with any safety concerns in clinical outcomes.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e887"},"PeriodicalIF":1.2,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201407","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 Framework for Building an Inclusive Quality Program in a Pediatric Heart Center.","authors":"Judson A Moore, Jennifer Marietta, Adam L Ware, David K Bailly, Kevin Hummel, Aaron W Eckhauser, Chuck G Pribble, Melissa M Winder, Tina Wadhwa, Emilee T Glenn, Ashlee Gardner, Megan Wichser, Haley Francione, Carly Heyrend, Chelsea Buckalew, Bethany Marullo, Venu Amula, Adil Husain, Antonio G Cabrera","doi":"10.1097/pq9.0000000000000880","DOIUrl":"10.1097/pq9.0000000000000880","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric heart centers have advanced quality improvement (QI) work through registries and collaboratives, improving benchmarking and shared learning. However, institutions must also build internal, sustainable QI programs tailored to local needs. We outlined our experience in developing an inclusive QI program that provides a structured framework to drive continuous improvement.</p><p><strong>Methods: </strong>We implemented a 5-step approach: (1) cultivating an environment ready for change, (2) optimizing streams to identify improvement opportunities, (3) building systems to support initiatives, (4) promoting QI work and successes, and (5) sustaining and scaling improvements. This included engaging diverse stakeholders, streamlining data, reducing participation barriers, and applying structured project management. Proposals underwent rigorous review to ensure equitable support.</p><p><strong>Results: </strong>Between 2021 and 2025, the program supported 17 subgroups across cardiology, surgery, anesthesia, and critical care, with 60% of projects led by nonphysicians. It facilitated 21 QI consults (71% progressing to formal projects), 13 publications, more than 30 national presentations, and additional impactful unpublished work, while strengthening leadership and team expertise through QI education. System-level outcomes improved, including surgical mortality and <i>US News & World Report</i> rankings. Performance rounds generated 170 improvement actions to guide systematic change.</p><p><strong>Conclusions: </strong>An inclusive QI program enhances outcomes, and our structure underscores the value of both multidisciplinary collaboration and strategic resource use. By investing in leadership, promoting diversity, and aligning with institutional goals, heart centers can achieve sustained improvement. This framework offers a potential model for institutions seeking robust QI infrastructure.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e880"},"PeriodicalIF":1.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201462","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":"Antibiotic Stewardship Quality Improvement Project for Neonatal Sepsis in a Tertiary NICU in Lima, Peru.","authors":"Carmen R Dávila-Aliaga, Elina R Mendoza Ibañez, Elsa Torres Marcos, Julia R Hinojosa Pérez, Claudia V Saldaña-Diaz, Andres Campaña-Acuña, Mary E Davila Peña, Maria Gabriela Soza Bieli Bianchi, Charley G Pariona Sulluchuco, Yulahima M Martínez Ortiz, Milagros E Macedo Villegas, Wendy L Mendoza Jamanca, Eyleen E Guibert Casós, Rafael Paucar Zegarra, Alfonso F Pantoja","doi":"10.1097/pq9.0000000000000884","DOIUrl":"10.1097/pq9.0000000000000884","url":null,"abstract":"<p><strong>Introduction: </strong>Preterm newborns in neonatal intensive care units face high antibiotic exposure despite low culture positivity. To address this, the National Maternal and Perinatal Institute, Peru, and the Andean Health Organization launched a project to reduce neonatal antibiotic use by 20% from May 2023 to May 2024.</p><p><strong>Method: </strong>A quality improvement project was designed at the National Maternal and Perinatal Institute in collaboration with the Andean Health Organization as part of a multinational initiative. The project used key driver identification and Plan-Do-Study-Act cycles to enhance antibiotic stewardship in early-onset sepsis (EOS) and late-onset sepsis (LOS) cases. Monitoring focused on identifying cases of treatment failure, recurrence, and mortality rate. We present results on Laney p'-charts stratified by EOS and LOS for the antibiotic use rate. Newborn characteristics are presented in comparative tables by sepsis type.</p><p><strong>Results: </strong>We included 647 newborns for suspected sepsis, comprising 982 episodes. Antibiotic use decreased by 17.3% for EOS and 25.9% for LOS. In EOS, rule-out sepsis was predominant (67.2%), whereas confirmed sepsis was predominant in LOS (40.6%). EOS was more common in term infants with a birth weight of 1,500 to 2,500 g, whereas LOS was predominant in preterms younger than 32 weeks with a birth weight of 1,000 to 1,500 g. No treatment failures or early recurrent sepsis were observed after discontinuation of antibiotics. No readmissions occurred within 30 days. EOS mortality was 15.8% and LOS mortality was 20.2%, with a decline in overall mortality from 3.5 to 3.0 per 1,000 live births across semesters.</p><p><strong>Conclusions: </strong>The quality improvement project improved neonatal sepsis management, reduced antibiotic use, and optimized treatment protocols.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e884"},"PeriodicalIF":1.2,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038537","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":"Accuracy of Various Methods for the Surveillance of Hospital-acquired Venous Thromboembolism in a Children's Hospital.","authors":"Robert Marcel T Huibonhoa, E Vincent S Faustino, Kimberly Burkiewicz, Phil Oelkers, Supriya Ravishankar, Sandeep Tripathi","doi":"10.1097/pq9.0000000000000882","DOIUrl":"10.1097/pq9.0000000000000882","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate measurement is important in quality improvement. <i>International Classification of Diseases</i> (ICD) codes are often used to measure hospital-acquired venous thromboembolism (HA-VTE) rates, but they have high detection error rates. Our objective was to compare HA-VTE rates of various automated calculation methods and their accuracy.</p><p><strong>Methods: </strong>Single-center retrospective study including children younger than 18 years admitted between 2018 and 2023. We developed 4 automated methods to identify potential HA-VTE cases using (1) ICD-10 codes, (2) vascular extremity ultrasound reports (USG), (3) hematology consult reasons (Heme), and (4) receipt of therapeutic-dosing enoxaparin (Meds). We reviewed charts to determine true HA-VTE, defined as the radiographic presence of a thrombus. Additionally, we reviewed all charts with a vascular extremity ultrasound performed during the study period for true HA-VTE. We computed the accuracy of each method.</p><p><strong>Results: </strong>Across 33,430 admissions, we detected 275 (0.82%) cases by ICD, 508 (1.5%) by USG, 151 (0.45%) by Heme, and 176 (0.53%) by Meds. We manually reviewed 869 charts, of which 180 (0.5%) had confirmed HA-VTE. The false-positive rate was highest for USG (70.7%), followed by ICD (52.4%), Heme (50.9%), and Meds (43.8%). The combined false-positive rate was 59.2%. Sensitivity was highest for USG (82.8%), followed by ICD (72.8%), Heme (41.1%), and Meds (55.0%). Specificity was highest for Meds and Heme (88.8%). Discriminative performance was best for Meds (with an area under the precision-recall curve: 44.3%).</p><p><strong>Conclusions: </strong>Combining multiple methods led to greater identification of HA-VTE without significantly increasing false-positive rates, making it useful for quality improvement surveillance. Detection based on Meds is a more accurate alternative to ICD codes.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e882"},"PeriodicalIF":1.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977756","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":"Standards of Care to Practice: Redefining Type 1 Diabetes Care within Learning Health Systems.","authors":"Melissa Leonard, Manmohan K Kamboj, Osagie Ebekozien","doi":"10.1097/pq9.0000000000000883","DOIUrl":"10.1097/pq9.0000000000000883","url":null,"abstract":"","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e883"},"PeriodicalIF":1.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977772","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 the First-hour Breastfeeding Rate in Cesarean Deliveries: A Quality Improvement Initiative.","authors":"Nalina Amuji, Clive Martin Rodrigues, Harshitha M Swamy, Lakshmi Parvathi Bandlamudi, Tinu Krishna Vilasam Regunath, Chandrakala Bada Shekharappa","doi":"10.1097/pq9.0000000000000879","DOIUrl":"10.1097/pq9.0000000000000879","url":null,"abstract":"<p><strong>Introduction: </strong>Breastfeeding during the golden hour after birth is crucial for establishing successful long-term breastfeeding. Despite the World Health Organization recommendation, according to the National Family Health Survey-5, the first-hour breastfeeding rate in India following cesarean delivery is only 23.9%. We aimed to improve the first-hour breastfeeding rate in stable neonates born through cesarean delivery from the baseline of 9% to 80% within a period of 4 weeks.</p><p><strong>Methods: </strong>This quality improvement initiative was conducted in Southern India during 8 months (April 2022 to November 2022) by a multidisciplinary team comprising doctors and nurses. The baseline first-hour breastfeeding rate among inborn, stable neonates of 34 weeks' gestation or greater delivered via cesarean section was assessed during a 10-week period. The Point Of Care Quality Improvement model (POCQI_learner_manual_ver 03_2020.pdf) was used to enhance the breastfeeding rate during 4 weeks. Successful change ideas were adopted, and their sustainability was evaluated during the 22-week sustenance period.</p><p><strong>Results: </strong>Out of the 592 neonates delivered by cesarean section at a gestational age of 34 weeks or older, 418 were eligible. The average gestational age and birth weight were 38 weeks (±1.4) and 2916 g (±489), respectively. The first-hour breastfeeding rate increased from a baseline of 9.6% to 100% at the conclusion of the intervention phase, and this was maintained at greater than 90% throughout the sustainability period.</p><p><strong>Conclusions: </strong>This quality improvement initiative enhances healthcare workers' knowledge, competence, and confidence in immediate first-hour breastfeeding within the operating theater. Further research is required to assess the potential for generalization across diverse units.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 3","pages":"e879"},"PeriodicalIF":1.2,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966003","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 Diagnostic Quality of Anogenital Photodocumentation in Emergency Department Evaluations for Acute Child Sexual Assault.","authors":"Zachary E Miller, Sara J Digirolamo, Jennifer Molnar, Colleen E Bennett, Sabrina Darwiche, Brandon C Ku, Philip V Scribano","doi":"10.1097/pq9.0000000000000876","DOIUrl":"10.1097/pq9.0000000000000876","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department evaluations for acute child sexual assault include anogenital photodocumentation as a standard of care, which has implications for accurate clinical care and forensic significance. If photodocumentation quality is suboptimal from a diagnostic standpoint, this may lead to wasted care and resources and place needless burdens on patients and families. Our project aimed to improve the diagnostic quality of anogenital photodocumentation at 2 sites in a pediatric emergency department, increasing it from a baseline of 24% to 50% during a 9-month intervention period.</p><p><strong>Methods: </strong>We surveyed multiple clinical teams to determine drivers of diagnostic quality. Using the Model for Improvement, we implemented multiple interventions (clinical pathway revisions, visual guidance, direct provider feedback, and an improved light source option) in the care process for these patients and measured diagnostic quality using a definition adapted from a validated photograph-scoring system. We used statistical process control charts to track diagnostic quality.</p><p><strong>Results: </strong>We detected no special-cause variation in the outcome measure of improved diagnostic quality. We detected special-cause variation for the process measure of whether care teams obtained photodocumentation, which increased from 77% to 89%.</p><p><strong>Conclusions: </strong>Interventions to improve the diagnostic quality of anogenital photodocumentation did not result in improvement; however, there was improvement in the likelihood of care teams obtaining photodocumentation in acute sexual assault evaluations.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"11 2","pages":"e876"},"PeriodicalIF":1.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13052962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635434","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}