Pediatric quality & safety最新文献_第6页

Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia. 质量改进计划加强了小儿肺科门诊对患有支气管肺发育不良的早产儿的随访。

Pediatric quality & safety Pub Date : 2024-06-07 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000736

Eliaz Brumer, Sanjiv Godse, Leela Chandrasekar, Tuba Kockar Kizilirmak, Eleanor Blythe, Yeisid Gozzo, Steven Peterec, Sarah Kandil, Matthew Grossman, Laura Chen, Pnina Weiss, Beverley Sheares

{"title":"Quality Improvement Initiative Enhances Outpatient Pediatric Pulmonology Follow-up for Premature Infants with Bronchopulmonary Dysplasia.","authors":"Eliaz Brumer, Sanjiv Godse, Leela Chandrasekar, Tuba Kockar Kizilirmak, Eleanor Blythe, Yeisid Gozzo, Steven Peterec, Sarah Kandil, Matthew Grossman, Laura Chen, Pnina Weiss, Beverley Sheares","doi":"10.1097/pq9.0000000000000736","DOIUrl":"10.1097/pq9.0000000000000736","url":null,"abstract":"Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disorder affecting many premature infants. Infants with BPD have higher hospital readmission rates due to respiratory-related morbidity. We aimed to increase the rates of outpatient pulmonary follow-up and attendance of premature babies with moderate and severe BPD to above 85% within 6 months.Methods: We conducted a quality improvement project at Yale New Haven Children's Hospital. Key interventions included developing a BPD clinical pathway integrated into the electronic medical record to assist providers in correctly classifying BPD severity, assigning the appropriate International Classification of Diseases, 10th Revision code (P27.1), and providing standardized treatment options. The outcome measures included correct diagnosis and classification of BPD, the percentage of patients with BPD scheduled for pediatric pulmonology appointments within 45 days, and the percentage attending those appointments.Results: There were 226 patients in our study, including 85 in the baseline period. Correct diagnosis of BPD increased from 49% to 95%, the percentage of scheduled appointments increased from 71.9% to 100%, and the percentage of appointments attended increased from 55.6% to 87.1%.Conclusions: Our quality improvement initiative improved the accuracy of diagnosis, severity classification, and outpatient pulmonary follow-up of children with moderate and severe BPD.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e736"},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11161285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297508","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}

引用次数: 0

Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening. 小儿 2 型糖尿病肾病筛查：提高质量，增加肾病筛查。

Pediatric quality & safety Pub Date : 2024-05-27 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000734

Elizabeth A Mann, Kelsi Alexander, Whitney Beaton, Elizabeth B Roe, Amy Grant, Kristin A Shadman

{"title":"Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening.","authors":"Elizabeth A Mann, Kelsi Alexander, Whitney Beaton, Elizabeth B Roe, Amy Grant, Kristin A Shadman","doi":"10.1097/pq9.0000000000000734","DOIUrl":"10.1097/pq9.0000000000000734","url":null,"abstract":"Background: Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%-75% over 6 months (September 2022-February 2023) and sustain that increase for 6 months (March through August 2023).Methods: A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date.Results: A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months.Conclusions: Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e734"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163107","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}

引用次数: 0

Improving Turnaround Time of Transabdominal Pelvic Ultrasounds with Ovarian Doppler in a Pediatric Emergency Department. 改善儿科急诊室使用卵巢多普勒经腹盆腔超声检查的周转时间。

Pediatric quality & safety Pub Date : 2024-05-27 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000730

Amanda S Dupont, Patrick C Drayna, Mark Nimmer, Shannon H Baumer-Mouradian, Kendra Wirkus, Danny G Thomas, Kevin Boyd, Sri S Chinta

{"title":"Improving Turnaround Time of Transabdominal Pelvic Ultrasounds with Ovarian Doppler in a Pediatric Emergency Department.","authors":"Amanda S Dupont, Patrick C Drayna, Mark Nimmer, Shannon H Baumer-Mouradian, Kendra Wirkus, Danny G Thomas, Kevin Boyd, Sri S Chinta","doi":"10.1097/pq9.0000000000000730","DOIUrl":"10.1097/pq9.0000000000000730","url":null,"abstract":"Introduction: Adnexal torsion is an emergent surgical condition. Transabdominal pelvic ultrasound (US) with ovarian Doppler is used to diagnose adnexal torsion and requires a sufficient bladder volume. Reduce the turnaround time for US by 25% in girls 8-18 years of age who present to the emergency department (ED) for 24 months.Methods: Our baseline period was from January 2020 to June 2021, and the intervention period was from July 2021 to June 2023. Patients 8-18 years old who required an US in the ED were included. There are two key drivers: early identification of US readiness and expeditious bladder filling. Interventions were (1) bladder volume screening; (2) utilization of bladder volume nomogram to identify US readiness; (3) epic order panels; and (4) rapid intravenous fluid method. The primary outcome was US turnaround time. Secondary outcomes were percentage of patients requiring invasive interventions to fill the bladder and patients with an US study duration of ≤45 minutes. The percent of patients screened by bladder scan was used as a process measure. Balancing measures used episodes of fluid overload and ED length of stay.Results: Turnaround time for USs improved from 112.4 to 101.6 minutes. The percentage of patients who had successful USs without invasive bladder filling improved from 32.1% to 42.6%. Bladder volume screening using a bladder scan increased from 40.3% to 82.9%. The successful first-pass US completion rate improved from 77% to 90% consistently.Conclusions: Through quality improvement methodology, we have identified pelvic US readiness earlier, eliminated some invasive bladder-filling measures, and implemented a rapid fluid protocol. We have sustained these successful results for 2 years. This study can be generalized to any ED with similar patients.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e730"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163101","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}

引用次数: 0

Beyond ltrasound Readiness: A Needs Assessment for Improving Care in Children with Ovarian Torsion. 超越超声准备：改善卵巢扭转患儿护理的需求评估》。

Pediatric quality & safety Pub Date : 2024-05-27 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000733

Shawn J Rangel

引用次数: 0

Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities. 质量改进发现患有先天性心脏病和残疾的青少年在医疗过渡方面存在差异。

Pediatric quality & safety Pub Date : 2024-05-27 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000732

Catherine C Allen, Briana L Swanson, Xiao Zhang, Ryan J Coller, Krisjon R Olson

{"title":"Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities.","authors":"Catherine C Allen, Briana L Swanson, Xiao Zhang, Ryan J Coller, Krisjon R Olson","doi":"10.1097/pq9.0000000000000732","DOIUrl":"10.1097/pq9.0000000000000732","url":null,"abstract":"Introduction: We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care.Methods: An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities.Results: HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001).Conclusions: Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e732"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141163105","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}

引用次数: 0

Transforming into a Learning Health System: A Quality Improvement Initiative. 向学习型医疗系统转型：质量改进计划。

Pediatric quality & safety Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000724

Jennifer L Chiem, Elizabeth E Hansen, Nicolas Fernandez, Paul A Merguerian, Sanjay R Parikh, Kayla Reece, Daniel K Low, Lynn D Martin

{"title":"Transforming into a Learning Health System: A Quality Improvement Initiative.","authors":"Jennifer L Chiem, Elizabeth E Hansen, Nicolas Fernandez, Paul A Merguerian, Sanjay R Parikh, Kayla Reece, Daniel K Low, Lynn D Martin","doi":"10.1097/pq9.0000000000000724","DOIUrl":"10.1097/pq9.0000000000000724","url":null,"abstract":"Background: The Institute of Medicine introduced the Learning Healthcare System concept in 2006. The system emphasizes quality, safety, and value to improve patient outcomes. The Bellevue Clinic and Surgical Center is an ambulatory surgical center that embraces continuous quality improvement to provide exceptional patient-centered care to the pediatric surgical population.Methods: We used statistical process control charts to study the hospital's electronic health record data. Over the past 7 years, we have focused on the following areas: efficiency (surgical block time use), effectiveness (providing adequate analgesia after transitioning to an opioid-sparing protocol), efficacy (creating a pediatric enhanced recovery program), equity (evaluating for racial disparities in surgical readmission rates), and finally, environmental safety (tracking and reducing our facility's greenhouse gas emissions from inhaled anesthetics).Results: We have seen improvement in urology surgery efficiency, resulting in a 37% increase in monthly surgical volume, continued adaptation to our opioid-sparing protocol to further reduce postanesthesia care unit opioid administration for tonsillectomy and adenoidectomy cases, successful implementation of an enhanced recovery program, continued work to ensure equitable healthcare for our patients, and more than 85% reduction in our facility's greenhouse gas emissions from inhaled anesthetics.Conclusions: The Bellevue Clinic and Surgical Center facility is a living example of a learning health system, which has evolved over the years through continued patient-centered QI work. Our areas of emphasis, including efficiency, effectiveness, efficacy, equity, and environmental safety, will continue to impact the community we serve positively.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e724"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946658","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}

引用次数: 0

Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease. 提高免疫抑制性风湿病儿科患者的肺炎球菌疫苗接种率。

Pediatric quality & safety Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000725

Julia G Harris, Jordan T Jones, Leslie Favier, Emily Fox, Michael J Holland, Amy Ivy, Cara M Hoffart, Maria Ibarra, Ashley M Cooper

{"title":"Improving Pneumococcal Vaccination Rates in Immunosuppressed Pediatric Patients with Rheumatic Disease.","authors":"Julia G Harris, Jordan T Jones, Leslie Favier, Emily Fox, Michael J Holland, Amy Ivy, Cara M Hoffart, Maria Ibarra, Ashley M Cooper","doi":"10.1097/pq9.0000000000000725","DOIUrl":"10.1097/pq9.0000000000000725","url":null,"abstract":"Background: Patients with rheumatic diseases are at a high risk of invasive pneumococcal disease due to immunosuppression. We conducted a quality improvement project, and the first aim was to increase the percentage of patients with systemic lupus erythematosus and mixed connective tissue disease that is up to date on pneumococcal vaccinations from 9.6% to 80% within one year. Subsequently, the second aim was to increase the percentage of patients on immunosuppression with systemic lupus erythematosus, mixed connective tissue disease, juvenile dermatomyositis and systemic vasculitis that is up to date on pneumococcal vaccinations from 62.6% to 80% within one year.Methods: Two process measures were up-to-date vaccination status on (1) 13-valent pneumococcal conjugated vaccine (PCV13) and (2) 23-valent pneumococcal polysaccharide vaccine (PPSV23). Our outcome measure was being fully up to date on both pneumococcal vaccinations. Interventions included an immunization algorithm, reporting of eligible patients, education, reminders, and pre-visit planning.Results: There were shifts in the centerline for all quality measures in both phases of this project. The combined pneumococcal vaccination rate for Phase 1 increased from 9.6% to 91.1%, and this centerline was sustained. Pneumococcal vaccination rates also significantly increased for Phase 2: 68.8% to 93.4% for PCV13, 65.2% to 88.5% for PPSV23, and 62.6% to 86.5% for the combined pneumococcal vaccination rate.Conclusions: Quality improvement methodology significantly increased and sustained pneumococcal vaccination rates in our high-risk, immunosuppressed patients. We continue to prioritize this important initiative to mitigate the risk of invasive pneumococcal disease.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e725"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946620","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}

引用次数: 0

Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action. 儿科重症监护室的心脏骤停后护理服务：计划和行动呼吁。

Pediatric quality & safety Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000727

Jessica A Barreto, Jesse Wenger, Maya Dewan, Alexis Topjian, Joan Roberts

{"title":"Postcardiac Arrest Care Delivery in Pediatric Intensive Care Units: A Plan and Call to Action.","authors":"Jessica A Barreto, Jesse Wenger, Maya Dewan, Alexis Topjian, Joan Roberts","doi":"10.1097/pq9.0000000000000727","DOIUrl":"10.1097/pq9.0000000000000727","url":null,"abstract":"Background: Despite national pediatric postcardiac arrest care (PCAC) guidelines to improve neurological outcomes and survival, there are limited studies describing PCAC delivery in pediatric institutions. This study aimed to describe PCAC delivery in centers belonging to a resuscitation quality collaborative.Methods: An institutional review board-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution in the international Pediatric Resuscitation Quality Improvement Collaborative. Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data.Results: Twenty-four of 47 centers (51%) completed the survey. Most respondents (58%) belonged to large centers (>1,000 annual pediatric intensive care unit admissions). Sixty-seven percent of centers reported no specific process to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Common PCAC targets included temperature (96%), age-based blood pressure (88%), and glucose (75%). Most PCAC included electroencephalogram (75%), but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological examination (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities.Conclusions: There is wide variation in PCAC delivery among surveyed pediatric institutions despite national guidelines to standardize and implement PCAC.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e727"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946623","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}

引用次数: 0

Emergency Department Initiative to Decrease High-flow Nasal Cannula Use for Admitted Patients with Bronchiolitis. 急诊科减少收治支气管炎患者使用高流量鼻导管的举措。

Pediatric quality & safety Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000728

Courtney E Nelson, Jonathan M Miller, Chalanda Jones, Emily Reese Fingado, Ann-Marie Baker, Julie Fausnaugh, Michael Treut, Leah Graham, Katlyn L Burr, Arezoo Zomorrodi

{"title":"Emergency Department Initiative to Decrease High-flow Nasal Cannula Use for Admitted Patients with Bronchiolitis.","authors":"Courtney E Nelson, Jonathan M Miller, Chalanda Jones, Emily Reese Fingado, Ann-Marie Baker, Julie Fausnaugh, Michael Treut, Leah Graham, Katlyn L Burr, Arezoo Zomorrodi","doi":"10.1097/pq9.0000000000000728","DOIUrl":"10.1097/pq9.0000000000000728","url":null,"abstract":"Background: Despite limited evidence, a high-flow nasal cannula (HFNC) is often used to treat mild to moderate (m/m) bronchiolitis. We aimed to decrease the rate of HFNC use in the pediatric emergency department (PED) for m/m bronchiolitis from a baseline of 37% to less than 18.5%.Methods: A multidisciplinary team created a bronchiolitis pathway and implemented it in December 2019. A respiratory score (RS) in the electronic medical record objectively classified bronchiolitis severity as mild, moderate, or severe. We tracked HFNC utilization in the PED among patients with m/m bronchiolitis as our primary outcome measure between December 2019 and December 2021. We monitored the percentage of patients with an RS as a process measure. Interventions through four plan-do-study-act cycles included updating the hospital oxygen therapy policy, applying the RS to all patients in respiratory distress, modifying the bronchiolitis order set, and developing a bronchiolitis-specific HFNC order.Results: Three hundred twenty-five patients were admitted from the PED with m/m bronchiolitis during the 11-month baseline period and 600 patients during the 25-month intervention period. The mean rate of HFNC utilization decreased from 37% to 17%. Despite a decrease in bronchiolitis encounters after the pandemic, in the spring of 2021, when volumes returned, we had a sustained HFNC utilization rate of 17%. RS entry increased from 60% to 73% in the intervention period.Conclusions: A clinical pathway for bronchiolitis can lead to decreased use of HFNC for m/m bronchiolitis. Consistent RS, order set development with decision support, and education led to sustained improvement despite pandemic-related volumes.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e728"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946648","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}

引用次数: 0

Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations through Shared Decision-making in the NICU. 协同安全：在新生儿重症监护室通过共同决策减少意外拔管的定制方法。

Pediatric quality & safety Pub Date : 2024-05-09 eCollection Date: 2024-05-01 DOI: 10.1097/pq9.0000000000000729

Parvathy Krishnan, Nilima Jawale, Adam Sodikoff, Susan R Malfa, Kathleen McCarthy, Lisa M Strickrodt, Diana D'Agrosa, Alexandra Pickard, Lance A Parton, Meenakshi Singh

{"title":"Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations through Shared Decision-making in the NICU.","authors":"Parvathy Krishnan, Nilima Jawale, Adam Sodikoff, Susan R Malfa, Kathleen McCarthy, Lisa M Strickrodt, Diana D'Agrosa, Alexandra Pickard, Lance A Parton, Meenakshi Singh","doi":"10.1097/pq9.0000000000000729","DOIUrl":"10.1097/pq9.0000000000000729","url":null,"abstract":"Background: Unplanned Extubation (UE) remains an important patient safety issue in the Neonatal Intensive Care Unit. Our SMART AIM was to decrease the rate of UE by 10% from the baseline from January to December 2022 by emphasizing collaboration among healthcare professionals and through the use of shared decision-making.Methods: We established an interdisciplinary Quality Improvement team composed of nurses, respiratory therapists, and physicians (MDs). The definition of UE was standardized. UE was audited using an apparent cause analysis form to discern associated causes and pinpoint areas for improvement. Interventions were implemented in a step-by-step fashion and reviewed monthly using the model for improvement. A shared decision-making approach fostered collaborative problem-solving.Results: Our baseline UE rate was 2.3 per 100 ventilator days. Retaping, general bedside care, and position change accounted for over 50% of the UE events in 2022. The rate of UE was reduced by 48% by the end of December 2022. We achieved special-cause variation by the end of March 2023.Conclusions: The sole education of medical and nursing providers about various approaches to decreasing unnecessary retaping was ineffective in reducing UE rates. Shared decision-making incorporating inputs from nurses, respiratory therapists, and MDs led to a substantial reduction in the UE rate and underscores the potential of systematic evaluation of risk factors combined with collaborative best practices.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"9 3","pages":"e729"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946627","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}

引用次数: 0