Sandra P. Spencer MD (is Associate Professor, Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.), Nathaniel H. Forman MD (formerly Pediatric Emergency Medicine Fellow, Nationwide Children's Hospital, Columbus, Ohio, is Attending Physician, Pediatric Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida.), Melissa G. Chung MD (is Attending Pediatric Neurologist and Critical Care Physician, Nationwide Children's Hospital, and Associate Professor of Clinical Pediatrics, Ohio State University College of Medicine.), Terri Dachenhaus RN, BSN, CPEN (is Nurse Supervisor, Division of Emergency Medicine, Nationwide Children's Hospital.), Annie I. Drapeau MD, MSc, FRCSC (formerly Pediatric Neurosurgeon, Nationwide Children's Hospital, is Pediatric Neurosurgeon and Assistant Professor, Section of Neurosurgery, University of Manitoba.), Christopher Gerity MPH, RT, MRSO (is Clinical Manager of MRI, Nationwide Children's Hospital.), Rodrigo Iglesias MS (is Quality Improvement Specialist, Center for Clinical Excellence, Nationwide Children's Hospital.), Jeremy Y. Jones MD (is Neuroradiology Section Chief, Department of Pediatric Radiology, Nationwide Children's Hospital.), Marlina E. Lovett MD (is Attending Physician, Division of Critical Care Medicine, Nationwide Children's Hospital, and Assistant Professor, Ohio State University College of Medicine.), Julie C. Leonard MD, MPH (is Associate Division Chief for Research in Emergency Medicine, Nationwide Children's Hospital, and Professor, Department of Pediatrics, Ohio State University College of Medicine. Please address correspondence to Sandra P. Spencer)
{"title":"提高小儿急性神经功能障碍患者的诊断和治疗时间。","authors":"Sandra P. Spencer MD (is Associate Professor, Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.), Nathaniel H. Forman MD (formerly Pediatric Emergency Medicine Fellow, Nationwide Children's Hospital, Columbus, Ohio, is Attending Physician, Pediatric Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida.), Melissa G. Chung MD (is Attending Pediatric Neurologist and Critical Care Physician, Nationwide Children's Hospital, and Associate Professor of Clinical Pediatrics, Ohio State University College of Medicine.), Terri Dachenhaus RN, BSN, CPEN (is Nurse Supervisor, Division of Emergency Medicine, Nationwide Children's Hospital.), Annie I. Drapeau MD, MSc, FRCSC (formerly Pediatric Neurosurgeon, Nationwide Children's Hospital, is Pediatric Neurosurgeon and Assistant Professor, Section of Neurosurgery, University of Manitoba.), Christopher Gerity MPH, RT, MRSO (is Clinical Manager of MRI, Nationwide Children's Hospital.), Rodrigo Iglesias MS (is Quality Improvement Specialist, Center for Clinical Excellence, Nationwide Children's Hospital.), Jeremy Y. Jones MD (is Neuroradiology Section Chief, Department of Pediatric Radiology, Nationwide Children's Hospital.), Marlina E. Lovett MD (is Attending Physician, Division of Critical Care Medicine, Nationwide Children's Hospital, and Assistant Professor, Ohio State University College of Medicine.), Julie C. Leonard MD, MPH (is Associate Division Chief for Research in Emergency Medicine, Nationwide Children's Hospital, and Professor, Department of Pediatrics, Ohio State University College of Medicine. Please address correspondence to Sandra P. Spencer)","doi":"10.1016/j.jcjq.2024.12.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Children presenting to the pediatric emergency department (PED) with neurologic dysfunction require prompt evaluation. Many PEDs successfully implement stroke alerts. However, most pediatric patients presenting with neurologic dysfunction have a non-stroke diagnosis better evaluated using magnetic resonance imaging (MRI). Therefore, we created a Neuro Deterioration clinical pathway using fast MRI to reduce time from PED arrival to completion of radiologic report by 25% in all PED patients presenting with new neurologic dysfunction.</div></div><div><h3>Methods</h3><div>After creating an algorithm and allocating resources, the team used quality improvement methodology to implement a Neuro Deterioration clinical pathway. Interventions focused on patient identification, patient flow, and electronic decision support. Statistical process control charting assessed interventions. The primary outcome measure was time from PED arrival to completion of radiologic report. Additional measures included time from arrival to image finish and percentage of patients on pathway.</div></div><div><h3>Results</h3><div>From 2018 to 2021, time from PED arrival to completion of radiologic report reduced by 32.2%. The average time decrease from a baseline of 211 (<em>n</em> = 287, January 2018–August 2019) to 143 minutes (<em>n</em> = 162, October 2020–December 2021), as noted by a centerline shift on the statistical process control chart. Average time from PED arrival to image finish decreased from 179 to 131 minutes. Percentage of patients on pathway increased. The average age of patients on pathway was 11.5 years, 63.8% were admitted, and 87.5% had a fast MRI for initial imaging. Of the 30.4% of patients with abnormal findings on initial imaging, 85.8% had non-stroke etiologies.</div></div><div><h3>Conclusion</h3><div>The authors created a sustainable Neuro Deterioration clinical pathway to improve time to diagnosis of all pediatric patients with neurologic findings in the PED.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 4","pages":"Pages 252-260"},"PeriodicalIF":2.3000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving Time to Diagnosis and Management of Pediatric Patients with Acute Neurologic Dysfunction\",\"authors\":\"Sandra P. Spencer MD (is Associate Professor, Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.), Nathaniel H. Forman MD (formerly Pediatric Emergency Medicine Fellow, Nationwide Children's Hospital, Columbus, Ohio, is Attending Physician, Pediatric Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, Florida.), Melissa G. Chung MD (is Attending Pediatric Neurologist and Critical Care Physician, Nationwide Children's Hospital, and Associate Professor of Clinical Pediatrics, Ohio State University College of Medicine.), Terri Dachenhaus RN, BSN, CPEN (is Nurse Supervisor, Division of Emergency Medicine, Nationwide Children's Hospital.), Annie I. Drapeau MD, MSc, FRCSC (formerly Pediatric Neurosurgeon, Nationwide Children's Hospital, is Pediatric Neurosurgeon and Assistant Professor, Section of Neurosurgery, University of Manitoba.), Christopher Gerity MPH, RT, MRSO (is Clinical Manager of MRI, Nationwide Children's Hospital.), Rodrigo Iglesias MS (is Quality Improvement Specialist, Center for Clinical Excellence, Nationwide Children's Hospital.), Jeremy Y. Jones MD (is Neuroradiology Section Chief, Department of Pediatric Radiology, Nationwide Children's Hospital.), Marlina E. Lovett MD (is Attending Physician, Division of Critical Care Medicine, Nationwide Children's Hospital, and Assistant Professor, Ohio State University College of Medicine.), Julie C. Leonard MD, MPH (is Associate Division Chief for Research in Emergency Medicine, Nationwide Children's Hospital, and Professor, Department of Pediatrics, Ohio State University College of Medicine. Please address correspondence to Sandra P. Spencer)\",\"doi\":\"10.1016/j.jcjq.2024.12.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Children presenting to the pediatric emergency department (PED) with neurologic dysfunction require prompt evaluation. Many PEDs successfully implement stroke alerts. However, most pediatric patients presenting with neurologic dysfunction have a non-stroke diagnosis better evaluated using magnetic resonance imaging (MRI). Therefore, we created a Neuro Deterioration clinical pathway using fast MRI to reduce time from PED arrival to completion of radiologic report by 25% in all PED patients presenting with new neurologic dysfunction.</div></div><div><h3>Methods</h3><div>After creating an algorithm and allocating resources, the team used quality improvement methodology to implement a Neuro Deterioration clinical pathway. Interventions focused on patient identification, patient flow, and electronic decision support. Statistical process control charting assessed interventions. The primary outcome measure was time from PED arrival to completion of radiologic report. Additional measures included time from arrival to image finish and percentage of patients on pathway.</div></div><div><h3>Results</h3><div>From 2018 to 2021, time from PED arrival to completion of radiologic report reduced by 32.2%. The average time decrease from a baseline of 211 (<em>n</em> = 287, January 2018–August 2019) to 143 minutes (<em>n</em> = 162, October 2020–December 2021), as noted by a centerline shift on the statistical process control chart. Average time from PED arrival to image finish decreased from 179 to 131 minutes. Percentage of patients on pathway increased. The average age of patients on pathway was 11.5 years, 63.8% were admitted, and 87.5% had a fast MRI for initial imaging. Of the 30.4% of patients with abnormal findings on initial imaging, 85.8% had non-stroke etiologies.</div></div><div><h3>Conclusion</h3><div>The authors created a sustainable Neuro Deterioration clinical pathway to improve time to diagnosis of all pediatric patients with neurologic findings in the PED.</div></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"51 4\",\"pages\":\"Pages 252-260\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725024003799\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024003799","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Improving Time to Diagnosis and Management of Pediatric Patients with Acute Neurologic Dysfunction
Background
Children presenting to the pediatric emergency department (PED) with neurologic dysfunction require prompt evaluation. Many PEDs successfully implement stroke alerts. However, most pediatric patients presenting with neurologic dysfunction have a non-stroke diagnosis better evaluated using magnetic resonance imaging (MRI). Therefore, we created a Neuro Deterioration clinical pathway using fast MRI to reduce time from PED arrival to completion of radiologic report by 25% in all PED patients presenting with new neurologic dysfunction.
Methods
After creating an algorithm and allocating resources, the team used quality improvement methodology to implement a Neuro Deterioration clinical pathway. Interventions focused on patient identification, patient flow, and electronic decision support. Statistical process control charting assessed interventions. The primary outcome measure was time from PED arrival to completion of radiologic report. Additional measures included time from arrival to image finish and percentage of patients on pathway.
Results
From 2018 to 2021, time from PED arrival to completion of radiologic report reduced by 32.2%. The average time decrease from a baseline of 211 (n = 287, January 2018–August 2019) to 143 minutes (n = 162, October 2020–December 2021), as noted by a centerline shift on the statistical process control chart. Average time from PED arrival to image finish decreased from 179 to 131 minutes. Percentage of patients on pathway increased. The average age of patients on pathway was 11.5 years, 63.8% were admitted, and 87.5% had a fast MRI for initial imaging. Of the 30.4% of patients with abnormal findings on initial imaging, 85.8% had non-stroke etiologies.
Conclusion
The authors created a sustainable Neuro Deterioration clinical pathway to improve time to diagnosis of all pediatric patients with neurologic findings in the PED.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
