Pediatric quality & safety最新文献

{"title":"Using Quality Improvement to Design and Evaluate an Outpatient Day Treatment Pathway for Pediatric Patients with Diabetes Mellitus Requiring Insulin Initiation.","authors":"Svetlana Azova, Charumathi Baskaran, Sara Einis, Jennifer Fortin, Marisa Silva, Miriam Gorman, Benjamin Ethier, Sonal Nanavati, Olivia Sterns, Katharine Garvey, Erinn T Rhodes","doi":"10.1097/pq9.0000000000000776","DOIUrl":"10.1097/pq9.0000000000000776","url":null,"abstract":"<p><strong>Introduction: </strong>Education and management of children with new-onset or established diabetes mellitus (DM) requiring insulin initiation do not always require hospitalization. We developed a pathway for outpatient day treatment of select patients after initial evaluation in the emergency department (ED) at a pediatric, tertiary care academic medical center.</p><p><strong>Methods: </strong>A multidisciplinary team identified key initial eligibility criteria for outpatient day treatment for insulin initiation, including absence of diabetic ketoacidosis, age ≥3 years, and plasma beta-hydroxybutyrate (BOHB) <1 mmol/L. Electronic medical record reviews and surveys administered to endocrine providers determined exclusions or reasons for nonparticipation. Refinement of the pathway occurred through iterative plan-do-study-act cycles. Statistical process control evaluated the uptake among eligible patients.</p><p><strong>Results: </strong>We launched the pathway in September 2020. Of 534 patients presenting to the ED with new-onset or established DM requiring insulin initiation in the first 2.5 years, 198 were potentially eligible for day treatment. Of these, 65 children (33%) completed the pathway. One additional patient was hospitalized following Day 1 of education due to newly identified psychosocial stressors. The increase of BOHB cutoff to 1.5 mmol/L and the option of rapid-acting insulin bolus for borderline BOHB resulted in a significant shift in utilization from a mean of 24.4% to 41.1%. Persistent barriers to participation include limited appointment availability, weekend presentation, and patient/family concerns.</p><p><strong>Conclusions: </strong>Outpatient day treatment was successful for select pediatric patients with new-onset or established DM requiring insulin initiation. However, this approach necessitates flexible resources and supportive patient messaging.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e776"},"PeriodicalIF":1.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Neonatal Hyperbilirubinemia Clinical Pathway in a Pediatric Emergency Department.","authors":"Collin R Miller, Catherine Haut, Arezoo Zomorrodi, Karina Chara, Janice Wilson","doi":"10.1097/pq9.0000000000000774","DOIUrl":"10.1097/pq9.0000000000000774","url":null,"abstract":"<p><strong>Background: </strong>High volumes and competing priorities delay care initiation for neonatal hyperbilirubinemia within the pediatric emergency department (ED). Our freestanding children's hospital developed a quality improvement project to implement a nurse-initiated neonatal hyperbilirubinemia clinical pathway (CP) intended to decrease treatment initiation and intravenous fluid (IVF) rates.</p><p><strong>Methods: </strong>A multidisciplinary team used the model for improvement to delineate and address key drivers of treatment delays. The team established a nurse-driven CP and enhanced the electronic health record to support and enforce new workflows, which included capillary specimen collection and phototherapy initiation before the first provider assessment. IVF criteria and laboratory evaluation were standardized. The primary aim was to decrease the time to initiation of phototherapy from a mean of 136 to 60 minutes after ED arrival for 6 months. The secondary aim was to decrease the proportion of patients obtaining IVF from 31% to 15% for the same time frame.</p><p><strong>Results: </strong>ED arrival to phototherapy initiation decreased from 136 to 49 minutes. The IVF rate decreased from 31% to 12%. ED length of stay decreased from 185 to 122 minutes. Hospital length of stay remained unchanged.</p><p><strong>Conclusions: </strong>A nurse-initiated CP for neonates with hyperbilirubinemia improved time-to-care initiation and ED throughput while decreasing unnecessary IVF administration.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e774"},"PeriodicalIF":1.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Business Case for Simulation-based Hospital Design Testing; $90M Saved in Costs Avoided.","authors":"Nora Colman, Christopher Chelette, Jayne Woodward, Misty Chambers, Kimberly Stanley, Sarah Walter, Vanessa Lampe Heimbuch, Caitlin Webster, Kiran Hebbar","doi":"10.1097/pq9.0000000000000775","DOIUrl":"10.1097/pq9.0000000000000775","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based hospital design testing (SbHDT) applied during the design of a healthcare facility ensures that the architectural design supports safe, high-quality, and efficient care delivery beyond applicable building code compliance. This prospective investigation assesses the financial impact of SbHDT in the form of cost avoidance.</p><p><strong>Methods: </strong>In designing a new free-standing 400+ bed children's hospital, SbHDT identified latent conditions early in the planning process to mitigate safety concerns related to the proposed design of 15 clinical areas. Architectural modifications were made to address concerns and resolve latent conditions before construction. The estimated cost of materials and labor to make an architectural change was documented for each architectural modification. Unit cost multiplied by unit count for each design element changed was summed together as total cost avoidance.</p><p><strong>Results: </strong>The cost to conduct the simulation was $1.6M (0.01% of overall project cost). Seven hundred twenty-two latent conditions were identified, and 57% of those latent conditions were mitigated by design changes. Ninety million dollars in costs were avoided by making design modifications before construction. Twenty-eight percent of latent conditions (n = 117) would have been cost-prohibitive to modify after construction.</p><p><strong>Conclusions: </strong>SbHDT harnessed evidence-based design to improve clinical care, optimize safety, and maximize investment. SbHDT was financially practical and had a significant impact on cost avoidance. Implementing SbHDT is associated with upfront costs, but long-term savings will accumulate over time through expenses avoided through mitigation of safety threats and operational savings.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 6","pages":"e775"},"PeriodicalIF":1.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11567707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient Management of Fever and Neutropenia in Low-risk Children with Solid Tumors: A Quality Improvement Initiative.","authors":"Wallace Bourgeois, Jonathan Paolino, Riley Garland, Kevin Campbell, Francesca Alvarez-Calderon, A Lindsay Frazier, Allison F O'Neill, Maya Ilowite, Chris I Wong","doi":"10.1097/pq9.0000000000000771","DOIUrl":"10.1097/pq9.0000000000000771","url":null,"abstract":"<p><strong>Background: </strong>Management of febrile neutropenia in pediatric oncology usually requires inpatient parenteral antibiotics after initial evaluation, but some patients at lower risk of sepsis could be safely managed outpatient. We describe a quality improvement project to increase outpatient management of fever and neutropenia.</p><p><strong>Methods: </strong>We designed a standardized algorithm for children with a solid tumor diagnosis and low risk for bacteremia. The aim was to achieve outpatient management for at least 80% of eligible patients within 20 months of project initiation. We used plan-do-study-act cycles to improve algorithm compliance, including optimizing medical record decision support, developing targeted educational materials and outreach, and restructuring outpatient processes to allow for close follow-up. We surveyed patients (age ≥12 y) and parents/caregivers to assess the impact of outpatient management.</p><p><strong>Results: </strong>The initiative led to 71% (n = 34) of eligible patients being managed as outpatients. Six percent (n = 2) of patients developed bacteremia, resulting in hospital admission. Fifteen of 26 parents/caregivers and five of 11 patients approached completed the survey. For the preferred setting of febrile neutropenia management, 83% of patients preferred to be home versus 40% of parents/caregivers. No patient expressed any of the three highest ratings in the question exploring fear regarding outpatient febrile neutropenia management versus 67% of parents/caregivers.</p><p><strong>Conclusions: </strong>Some children with a solid tumor diagnosis at low risk for bacteremia are safely managed for febrile neutropenia as outpatients. Targeted efforts to engage parents/caregivers early in this practice change are necessary for success.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e771"},"PeriodicalIF":1.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Quality Improvement Initiative to Reduce Duplicate Inflammatory Marker Use.","authors":"Kathryn E Bakkum, Kathy H Stoner, David A Gannon, Thomas B Mike, Prabi Rajbhandari","doi":"10.1097/pq9.0000000000000769","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000769","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory markers (IMs) are often ordered in multiples, even though evidence suggests that this does not add any clinical benefit. The project aimed to reduce the number of duplicate IMs for patients by 10% in 12 months.</p><p><strong>Methods: </strong>We implemented a quality improvement (QI) project at our hospital, focusing on patients admitted to the pediatric hospital medicine service. The team chose the model for improvement as the QI methodology. Key interventions included ongoing provider education, integrating the project into the physician incentive plan, and reviewing disease-specific pathways. The primary outcome measure was \"duplicate IM use,\" which was defined as any two or more IMs (procalcitonin, C-reactive protein, or erythrocyte sedimentation rate) obtained on the same patient within 24 hours. The secondary outcome measure was any IM use during their stay, and the balancing measures were average complete blood count use, hospital length of stay, and 7-day readmission rate.</p><p><strong>Results: </strong>The baseline duplicate IM use, and any IM use was 43% and 19%, respectively. After the start of this QI project, duplicate IM use decreased to 12%, and the use of any IM also decreased to 12%. Complete blood count use varied from 11% to 24% during the project without obvious correlation to IM use. Hospital length of stay decreased from 2.5 to 2.6 days, and the 7-day readmission rate remained at 2.8%.</p><p><strong>Conclusions: </strong>The duplicate IM use and IM use were decreased without a concurrent increase in the balancing measures, indicating that a safe reduction of IM testing is feasible in inpatient pediatric care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 5","pages":"e769"},"PeriodicalIF":1.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11412711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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}