Pediatric quality & safety最新文献

{"title":"Improving Pediatric Ovarian Torsion Evaluation in the Pediatric Emergency Department: A Quality Improvement Initiative.","authors":"Brian L Park, Sara Fenstermacher, A Luana Stanescu, Lori Rutman, Lauren Kinneman, Patrick Solari","doi":"10.1097/pq9.0000000000000709","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000709","url":null,"abstract":"<p><strong>Background: </strong>Transabdominal pelvic ultrasound (TPUS) is the diagnostic test of choice for the evaluation of ovarian torsion, a time-sensitive surgical emergency. A full bladder is required to visualize the ovaries. Bladder filling is a time-consuming process leading to delays to TPUS, poor visualization of ovaries requiring repeat studies, and prolonged emergency department length of stay (ED LOS). The primary objective was to decrease the time to TPUS by standardizing the bladder filling process.</p><p><strong>Methods: </strong>This quality improvement initiative occurred at a single, academic, quaternary-care children's hospital ED and utilized the Institute for Healthcare Improvement Model for Improvement with sequential plan-do-study-act cycles. The first set of interventions implemented in August 2021 included a new electronic order set and bladder scan by ED nurses. Subsequent plan-do-study-act cycles aimed to decrease the time to intravenous fluid, decrease fluid requirement, and decrease the need for intravenous fluid. The primary outcome measure was the monthly mean time to TPUS. Secondary outcome measures included monthly mean ED LOS and percentage of repeat TPUS. We performed data analysis with statistical process control charts to assess for system change over time.</p><p><strong>Results: </strong>The preintervention baseline included 292 ED encounters more than 10 months, and postintervention analysis included 526 ED encounters more than 16 months. Time to TPUS decreased (138-120 min), ED LOS decreased (372-335 min), and repeat TPUS decreased (18% to 4%). All changes met the rules for special cause variation.</p><p><strong>Conclusions: </strong>Standardizing the bladder filling process was associated with decreased time to TPUS, ED LOS, and repeat TPUS.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e709"},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813813","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":"Increasing COVID-19 Immunization Rates through a Vaccination Program for Hospitalized Children.","authors":"Victoria Mattick, Katelyn Cappotelli Nevin, Anne Fallon, Stephanie Northwood Darrow, Suzanne Ramazani, Travis Dick, Tina Sosa","doi":"10.1097/pq9.0000000000000704","DOIUrl":"10.1097/pq9.0000000000000704","url":null,"abstract":"<p><strong>Introduction: </strong>Inpatient coronavirus disease 2019 (COVID-19) vaccination initiatives offer a novel strategy to eliminate barriers to care, provide access to interprofessional teams, and decrease COVID-19 morbidity and mortality. Our inpatient vaccination initiative aimed to triple the baseline rate of eligible hospitalized children vaccinated against COVID-19 from 0.95% to 2.85% from December 2021 to June 2022.</p><p><strong>Methods: </strong>We implemented a COVID-19 vaccination program for pediatric inpatients eligible to receive a dose based on age, current guidelines, and prior doses received. Key drivers included immunization counseling training, identification of eligible patients, and a streamlined workflow. The outcome measure was the percentage of eligible patients who received a vaccine dose during hospitalization. The process measures included the percentage of age-eligible patients who were appropriately screened for prior doses on admission. We designed a clinical decision support system to enhance eligibility identification. The team performed a health equity analysis which stratified patients by social vulnerability index.</p><p><strong>Results: </strong>During the study period, the average percentage of eligible hospitalized patients vaccinated increased from 0.9% to 3.5%, representing special cause variation and a centerline shift. The average percentage of age-eligible patients screened for prior vaccine doses on admission increased from 66.5% to 81.5%. Patients were more likely to be vaccinated if their clinician was exposed to the clinical decision support system (<i>P</i> < 0.01). The social vulnerability index analysis showed no significant differences.</p><p><strong>Conclusions: </strong>This COVID-19 vaccination initiative highlights how an interprofessional approach can increase vaccination rates in hospitalized children; however, overall inpatient COVID-19 vaccination rates in this setting remained low.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e704"},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500433","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":"Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI.","authors":"Monica D Combs, Danica B Liberman, Vivian Lee","doi":"10.1097/pq9.0000000000000705","DOIUrl":"10.1097/pq9.0000000000000705","url":null,"abstract":"<p><strong>Background: </strong>Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months.</p><p><strong>Methods: </strong>Quality improvement initiative at a children's hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI. Our primary and secondary outcomes were blood culture collection rate and positivity rate, respectively. Interventions focused on three key drivers: academic detailing, physician awareness of personal performance, and data transparency.</p><p><strong>Results: </strong>Over the 2-year study period, there were 105 blood cultures collected in 223 hospitalized patients. Blood culture collection rates demonstrated special cause variation, decreasing from 63.5% to 24.5%. For patients with UTI, 86% (18/21) of blood cultures were negative, whereas 100% were negative for CAP and SSTI. All three patients with bacteremic UTI had a concurrent urine culture growing the same pathogen. Balancing measures remained unchanged, including escalation to a higher level of care and return to the emergency department or hospital within 14 days for the same infection.</p><p><strong>Conclusions: </strong>A multifaceted quality improvement approach can reduce blood culture collection for hospitalized patients with CAP, SSTI, and UTI without significant changes to balancing measures. Despite the reduction achieved, the near-universal negative culture results suggest continued overutilization and highlight the need for more targeted approaches to blood culture collection.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e705"},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500421","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":"Decreasing ICU and Hospital Length of Stay through a Standardized Respiratory Therapist-driven Electronic Clinical Care Pathway for Status Asthmaticus.","authors":"Merrick Lopez, Michele Wilson, Ekua Cobbina, Danny Kaufman, Julie Fluitt, Michele Grainger, Robert Ruiz, Gulixian Abudukadier, Michael Tiras, Bronwyn Carlson, Jeane Spaid, Kim Falsone, Invest Cocjin, Anthony Moretti, Chad Vercio, Cynthia Tinsley, Harsha K Chandnani, Carlos Samayoa, Carissa Cianci, James Pappas, Nancy Y Chang","doi":"10.1097/pq9.0000000000000697","DOIUrl":"10.1097/pq9.0000000000000697","url":null,"abstract":"<p><strong>Introduction: </strong>Status asthmaticus (SA) is a cause of many pediatric hospitalizations. This study sought to evaluate how a standardized asthma care pathway (ACP) in the electronic medical record impacted the length of stay (LOS).</p><p><strong>Methods: </strong>An interdisciplinary team internally validated a standardized respiratory score for patients admitted with SA to a 25-bed pediatric intensive care unit (PICU) at a tertiary children's hospital. The respiratory score determined weaning schedules for albuterol and steroid therapies. In addition, pharmacy and information technology staff developed an electronic ACP within our electronic medical record system using best practice alerts. These best practice alerts informed staff to initiate the pathway, wean/escalate treatment, transition to oral steroids, transfer level of care, and complete discharge education. The PICU, stepdown ICU (SD ICU), and acute care units implemented the clinical pathway. Pre- and postintervention metrics were assessed using process control charts and compared using Welch's <i>t</i> tests with a significance level of 0.05.</p><p><strong>Results: </strong>Nine hundred two consecutive patients were analyzed (598 preintervention, 304 postintervention). Order set utilization significantly increased from 68% to 97% (<i>P</i> < 0.001), PICU LOS decreased from 38.4 to 31.1 hours (<i>P</i> = 0.013), and stepdown ICU LOS decreased from 25.7 to 20.9 hours (<i>P</i> = 0.01). Hospital LOS decreased from 59.5 to 50.7 hours (<i>P</i> = 0.003), with cost savings of $1,215,088 for the patient cohort.</p><p><strong>Conclusions: </strong>Implementing a standardized respiratory therapist-driven ACP for children with SA led to significantly increased order set utilization and decreased ICU and hospital LOS. Leveraging information technology and standardized pathways may improve care quality, outcomes, and costs for other common diagnoses.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e697"},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500422","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 Asthma Action Plan Completion Rates across Five Divisions in an Academic Children's Hospital.","authors":"Maria G Alfieri, Katie Catalano, Tregony Simoneau, Linda Haynes, Patricia Glidden, Sachin N Baxi, Ramy Yim, Benjamin Ethier, Faye F Holder-Niles, Kendall McCarty, Frinny Polanco Walters, Eli Sprecher, Amy Starmer, Jonathan M Gaffin, Jeffrey Durney, Elizabeth Klements, Brittany Esty","doi":"10.1097/pq9.0000000000000700","DOIUrl":"10.1097/pq9.0000000000000700","url":null,"abstract":"<p><strong>Introduction: </strong>Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021.</p><p><strong>Methods: </strong>We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients. The divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, and two Primary Care sites) participated in the QI process using tools to understand the problem context. They implemented a cross-divisional AAP completion competition from June to October 2021. Each month during Action Periods, divisions trialed their interventions using Plan-Do-Study-Act cycles. We held monthly Learning Sessions for divisions to collaborate on successful intervention strategies.</p><p><strong>Results: </strong>Statistical process control chart analysis demonstrated that the overall AAP completion rate increased from a baseline of 80% to 87% with the initiation of the competition. All divisions showed improvement in AAP completion rates during the active intervention period, but sustainment varied.</p><p><strong>Conclusions: </strong>The cross-divisional competition motivated five divisions to improve processes to increase AAP completion rates. This approach effectively fostered engagement and idea sharing to boost performance, and may be considered for other QI projects.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 6","pages":"e700"},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10697594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500432","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":"Closing the Fluid Gap: Improving Isotonic Maintenance Intravenous Fluid Use in a Community Hospital Network.","authors":"Shraddha Mittal,&nbsp;Sheila Knerr,&nbsp;Julianne Prasto,&nbsp;Jessica Hunt,&nbsp;Carolyn Mattern,&nbsp;Tsae Chang,&nbsp;Ronald Marchese,&nbsp;Morgan Jessee,&nbsp;Lauren Marlowe,&nbsp;Josh Haupt","doi":"10.1097/pq9.0000000000000696","DOIUrl":"10.1097/pq9.0000000000000696","url":null,"abstract":"<p><strong>Introduction: </strong>The American Academy of Pediatrics recommends using isotonic intravenous fluids (IVF) for maintenance needs to decrease the risk of hyponatremia. We conducted a quality improvement project to increase the use of isotonic maintenance IVF in pediatric patients admitted to three sites in a community hospital network to >85% within 12 months.</p><p><strong>Methods: </strong>We used improvement methodology to identify causes of continued hypotonic fluid use, which involved provider behavior and systems factors. We implemented interventions to address these factors including: (1) education; (2) clinical decision support; and (3) stocking automated medication dispensing systems with isotonic IVF. We compared isotonic IVF use before and after interventions in all admitted patients aged 28 days to 18 years who received maintenance IVFs at the rate of at least 10 mL/hour. We excluded admissions of patients with active chronic medical conditions like diabetic ketoacidosis. Balancing measures were the occurrence of adverse events from hypo- or hypernatremia. Data were analyzed using Laney P' statistical process control charts.</p><p><strong>Results: </strong>Isotonic IVF use among patients requiring maintenance fluids at all three sites surpassed the goal of >85% within 12 months. There were no reports of hypo- or hypernatremia or other adverse outcomes related to the use of isotonic IVF.</p><p><strong>Conclusion: </strong>A combination of interventions aimed at provider behavior and systems factors was critical to successfully adopting the American Academy of Pediatrics guideline regarding the use of maintenance isotonic IVF in hospitalized children.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e696"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222824","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":"Handoff Tool Improves Transitions from the Operating Room to the Neonatal Intensive Care Unit.","authors":"Julie B Gallois,&nbsp;Jessica A Zagory,&nbsp;Brian Barkemeyer,&nbsp;Michelle Knecht,&nbsp;Lauren Richard,&nbsp;Kathleen Vincent,&nbsp;David Sciacca,&nbsp;Crystal Maise-Dykes,&nbsp;Christy Mumphrey","doi":"10.1097/pq9.0000000000000695","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000695","url":null,"abstract":"<p><strong>Introduction: </strong>Standardized handoffs reduce medical errors and prevent adverse events or near misses. This article describes a quality improvement initiative implementing a unique standardized handoff tool and process to transition from the operating room to the neonatal intensive care unit (NICU) at a level-four regional center with many inpatients requiring surgical intervention. Before this project, there was no standardized handoff tool or process for postsurgical transitions. The primary aim was to achieve 80% compliance with completing a structured postoperative OR to NICU handoff tool within 12 months of implementation.</p><p><strong>Methods: </strong>An interdisciplinary team developed and implemented a standardized NICU postoperative handoff tool and process that requires face-to-face communication, defines team members who should be present, and highlights communication with the family. In addition, the handoff tool compliance and process measures were monitored, evaluated, and audited.</p><p><strong>Results: </strong>Although not consistent, we achieved eighty percent compliance with the outcome measures using the handoff tool. We did not sustain 80% of appropriate providers present at handoff. In addition, insufficient data assess overall parental satisfaction with the surgical experience. Although improved, the process measure of immediate postoperative family updates did not reach the targeted goal. However, the balancing measure of staff experience and satisfaction did improve.</p><p><strong>Conclusion: </strong>Implementing a standardized handoff tool and process with an interdisciplinary and interdepartmental collaboration improves critical patient transitions from the operating room to the NICU.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e695"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222825","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":"Identifying Children in Foster Care and Improving Foster Care Documentation in Primary Care.","authors":"Camille A Broussard, Julia M Kim, Brittany Hunter, LaToya Mobley, Maria Trent, Rebecca Seltzer","doi":"10.1097/pq9.0000000000000699","DOIUrl":"10.1097/pq9.0000000000000699","url":null,"abstract":"<p><strong>Background: </strong>Children and youth in foster care (CYFC) are a population with special healthcare needs, and the American Academy of Pediatrics has healthcare standards to care for this population, but implementation challenges include identifying clinic patients in foster care (FC). Documentation of FC status in the Electronic Health Record (EHR) can support the identification of CYFC to tailor care delivery. Therefore, we aimed to improve the percentage of CYFC with problem list (PL) documentation of FC status from 20% to 60% within 12 months.</p><p><strong>Methods: </strong>This study used a five-cycle plan-do-study-act quality improvement model in two co-located primary care teaching clinics. The primary outcome was the weekly percentage of patients with FC status on EHR PL. Ishikawa cause and effect analysis and resident survey identified barriers and informed interventions: education, patient list distribution, documentation training, email reminders, and clinic champion. We constructed statistical process control charts of the primary outcome to assess for improvement.</p><p><strong>Results: </strong>Mean weekly percentage of patients with FC status on PL improved from 19.8% to 60.2%. The most extensive improvements occurred after designating a clinic champion and providing email reminders with enhanced patient lists. The sustainability of PL documentation (mean = 71.7%) was demonstrated 3-4 years after the completion of plan-do-study-act cycle interventions.</p><p><strong>Conclusions: </strong>Educating providers, collaborating with child welfare to provide patient lists to providers, standardizing documentation, and designating clinic champions are promising methods of improving EHR documentation of FC status. Identifying and documenting FC status are important initial steps to optimizing care for this vulnerable population in primary care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e699"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/63/pqs-8-e699.PMC10561793.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222826","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 Improving Birth-dose Hepatitis-B Vaccination in a Tertiary Level IV Neonatal Intensive Care Unit.","authors":"Indirapriya Avulakunta,&nbsp;Palanikumar Balasundaram,&nbsp;Alma Rechnitzer,&nbsp;Toshiba Morgan-Joseph,&nbsp;Suhas Nafday","doi":"10.1097/pq9.0000000000000693","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000693","url":null,"abstract":"Background: Perinatal hepatitis B is a global public health concern. To reduce perinatal hepatitis B and its complications, the Hepatitis B vaccine (HBV) is recommended by the New York State Department of Health and Advisory Committee on Immunization Practices within 24 hours of life for infants born with a birth weight ≥2000 g. Infants admitted to the neonatal intensive care unit (NICU) weighing over 2000 g missed their birth dose HBV frequently, which prompted the implementation of a quality improvement initiative to increase birth dose HBV immunization in a level IV NICU in New York. Methods: May 2019 to April 2021 baseline data showed the birth dose HBV rate of infants born ≥2000 g at 24% and 31% within 12 and 24 hours, respectively. The multidisciplinary QI team identified barriers using an Ishikawa cause-and-effect diagram. Our interventions included multidisciplinary collaboration, electronic medical record reminders, education, posters, and improved communication between staff and parents. We aimed to achieve a 25% improvement from the baseline. Results: After 19 months of QI interventions (four Plan-Do-Study-Act cycles), the rate of administering birth dose HBV within 12 hours of life increased from 24% to 56% and within 24 hours from 31% to 64%. Process measure compliance improved, exceeding the 25% target, and showed sustained improvement. Conclusion: This QI initiative improved the rate of eligible infants receiving HBV within the first 24 hours of life in the NICU. This work can serve as a model for other healthcare institutions to improve HBV immunization rates in NICUs.","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e693"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/e8/pqs-8-e693.PMC10561802.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222823","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 Overutilization of High-flow Nasal Cannula in Children with Bronchiolitis.","authors":"Diana Jo,&nbsp;Nisha Gupta,&nbsp;David Bastawrous,&nbsp;Hayley Busch,&nbsp;Asha Neptune,&nbsp;Amy Weis,&nbsp;Courtney Port","doi":"10.1097/pq9.0000000000000690","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000690","url":null,"abstract":"<p><strong>Background: </strong>Bronchiolitis is a leading cause of pediatric hospitalizations. A high-flow nasal cannula (HFNC) does not significantly improve clinical outcomes and is associated with increased costs and intensive care unit (ICU) utilization. Despite this, hospitals continue to overuse HFNC in children with bronchiolitis. We aimed to reduce HFNC initiation in children hospitalized with bronchiolitis by 20 percentage points within 6 months.</p><p><strong>Methods: </strong>This study included patients aged 1 month to 2 years diagnosed with bronchiolitis, excluding patients with prematurity less than 32 weeks or preexisting cardiopulmonary, genetic, congenital, or neuromuscular abnormalities. Measures included HFNC utilization, length of stay, length of oxygen supplementation (LOOS), ICU transfers, and emergency department (ED) revisits and readmissions. For our primary intervention, we implemented a HFNC initiation protocol incorporating a respiratory scoring system, a multidisciplinary care-team huddle, and an emphasis on supportive care. Staff education, electronic health record integration, and audit and feedback were used to support implementation. Statistical process control charts were used to track metrics.</p><p><strong>Results: </strong>We analyzed 325 hospitalizations (126 baseline and 199 postintervention). The proportion of children hospitalized with bronchiolitis who received HFNC decreased from a mean of 82% to 60% within 1 month of implementation. Length of stay decreased from a median of 54 to 42 hours, and length of oxygen supplementation decreased from 50 to 38 hours. There were no significant changes in ICU transfers, 7-day ED revisits, or readmissions.</p><p><strong>Conclusions: </strong>Implementing a HFNC initiation protocol can safely reduce the overutilization of HFNC in children hospitalized with bronchiolitis.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":"8 5","pages":"e690"},"PeriodicalIF":0.0,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222847","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}