scholarly journals A Quality Improvement Initiative to Increase the Number of Pediatric Resident Laceration Repairs

2020 ◽  
Vol 12 (1) ◽  
pp. 51-57
Author(s):  
Tracey L. Wagner ◽  
Michael W. Dunn ◽  
Maya S. Iyer ◽  
Don Buckingham ◽  
Sandra P. Spencer
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Tertiary Hospital ◽  
Pediatric Emergency ◽  
Quality Improvement Initiative ◽  
Pediatric Resident ◽  
Statistical Process ◽  
Pediatric Residents ◽  
Control Charting ◽  
Clinical Procedures

ABSTRACT Background Pediatric residents must demonstrate competence in several clinical procedures prior to graduation, including simple laceration repair. However, residents may lack opportunities to perform laceration repairs during training, affecting their ability and confidence to perform this procedure. Objective We implemented a quality improvement initiative to increase the number of laceration repairs logged by pediatric residents from a baseline mean of 6.75 per month to more than 30 repairs logged monthly. Methods We followed the Institute for Healthcare Improvement's Model for Improvement with rapid plan-do-study-act cycles. From July 2016 to February 2018, we increased the number of procedure shifts and added an education module on performing laceration repairs for residents in a pediatric emergency department at a large tertiary hospital. We used statistical process control charting to document improvement. Our outcome measure was the number of laceration repairs documented in resident procedure logs. We followed the percentage of lacerations repairs completed by residents as a process measure and length of stay as a balancing measure. Results Following the interventions, logged laceration repairs initially increased from 6.75 to 22.75 per month for the residency program. After the number of procedure shifts decreased, logged repairs decreased to 13.40 per month and the percentage of lacerations repaired by residents also decreased. We noted an increased length of stay for patients whose lacerations were repaired by residents. Conclusions While our objective was not met, our quality improvement initiative resulted in more logged laceration repairs. The most effective intervention was dedicated procedure shifts.

scholarly journals A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 301
Author(s):  
Andrew M. Dylag ◽  
Jamey Tulloch ◽  
Karen E. Paul ◽  
Jeffrey M. Meyers
Keyword(s):  
Quality Improvement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Control Charts ◽  
Fluid Management ◽  
Delivery Room ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Golden Hour ◽  
Surfactant Administration

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Improving the Timely Delivery of Antihypertensive Medication for Severe Perinatal Hypertension in Pregnancy and Postpartum

2021 ◽  
Author(s):  
Patrick Schneider ◽  
Patricia Ann Lee King ◽  
Lauren Keenan-Devlin ◽  
Ann E.B. Borders
Keyword(s):  
Quality Improvement ◽  
Postpartum Period ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Elevated Blood ◽  
Statistical Process ◽  
Pregnancy And Postpartum ◽  
Blood Pressures ◽  
The Impact ◽  
Timely Delivery

Objective Sustained blood pressures ≥160/110 during pregnancy and the postpartum period require timely antihypertensive therapy. Hospital-level experiences outlining the efforts to improve timely delivery of care within 60 minutes have not been described. The objective of this analysis was to assess changes in care practices of an inpatient obstetrical health care team following the implementation of a quality improvement initiative for severe perinatal hypertension during pregnancy and the postpartum period. Study Design In January 2016, NorthShore University HealthSystem Evanston Hospital launched a quality improvement initiative focusing on perinatal hypertension, as part of a larger, statewide quality initiative via the Illinois Perinatal Quality Collaborative. We performed a retrospective cohort study of all pregnant and postpartum patients with sustained severely elevated blood pressure (two severely elevated blood pressures ≤15 minutes apart) with baseline data from 2015 and data collected during the project from 2016 through 2017. Changes in clinical practice and outcomes were compared before and after the start of the project. Statistical process control charts were used to demonstrate process-behavior changes over time. Results Comparing the baseline to the last quarter of 2017, there was a significant increase in the administration of medication within 60 minutes for severe perinatal hypertension (p <0.001). Implementation of a protocol for event-specific debriefing for each severe perinatal hypertension episode was associated with increased odds of the care team administering medication within 60 minutes of the diagnosis of severe perinatal hypertension (adjusted odds ratio 3.20, 95% confidence interval 1.73–5.91, p < 0.01). Conclusion Implementation of a quality improvement initiative for perinatal hypertension associated with pregnancy and postpartum improved the delivery of appropriate and timely therapy for severely elevated blood pressures and demonstrated the impact of interdisciplinary communication in the process. Key Points

scholarly journals Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis

BMJ ◽  
2011 ◽  
Vol 342 (jan28 1) ◽  
pp. d219-d219 ◽  
Author(s):  
A. Lipitz-Snyderman ◽  
D. Steinwachs ◽  
D. M. Needham ◽  
E. Colantuoni ◽  
L. L. Morlock ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Comparative Analysis ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Quality Improvement Initiative

scholarly journals A Quality Improvement Initiative: Improving Time-to-Antibiotics for Pediatric Oncology Patients with Fever and Suspected Neutropenia

2020 ◽  
Author(s):  
David E Kram ◽  
Kia Salafian ◽  
Sarah M Reel ◽  
Emily Nance Johnson ◽  
Brianna Borsheim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pediatric Oncology ◽  
Pediatric Emergency ◽  
Quality Improvement Initiative ◽  
Pediatric Emergency Department ◽  
Intervention Period ◽  
Oncology Patients ◽  
Time To Antibiotics ◽  
Antibiotic Delivery

ABSTRACTBackgroundThere is a high risk for adverse outcomes in immunocompromised, neutropenic pediatric oncology patients with fever if antibiotics are not received in a timely manner. As the absolute neutrophil count is typically unknown at the onset of fever, rapid antibiotic administration for all pediatric oncology patients with fever and suspected neutropenia is critical.Local ProblemDespite efforts over the years to meet the standard of time-to-antibiotic delivery to within 60 minutes of arrival, audits revealed a prolonged and wide-ranging time-to-antibiotics in our pediatric emergency department.MethodsWe conducted a quality improvement initiative to reduce the time to antibiotic delivery for this high risk patient population. The setting was a pediatric emergency department in an academic tertiary care hospital. We assembled a multidisciplinary team to apply quality improvement methods to understand the problem, implement interventions, and evaluate the outcomes.InterventionsWe targeted delays in patient triage, delays in antibiotic ordering, delays in antibiotic choice, and delays in bedside indwelling Port-a-Cath accessing procedure. Among other interventions, we instituted three unique measures: ceftriaxone was administered to all pediatric oncology patients with suspected neutropenia and fever; a system of ordering antibiotics that was driven by the ED pharmacist obtaining a verbal order from the ED attending; and a nurse-driven order set triggered by a unique triage category which empowered nurses to access a patient’s central line, draw and send specified blood work, and deliver an intravenous antibiotic, all potentially before an ED provider sees the patient.ResultsOver a sustained 3 year period of time, the percentage of febrile oncology patients with suspected neutropenia who met the target time-to-antibiotic delivery rose from 51% to 96%. The mean time-to-antibiotic delivery fell from 58 minutes in the pre-intervention period to 28 minutes in the post-intervention period.ConclusionsThe interventions implemented by the multidisciplinary team, using quality improvement methodology, successfully improved the percentage of febrile oncology patients receiving antibiotics within 60 minutes of arrival to a pediatric emergency department.

scholarly journals 1230: EARLIER EXTUBATION IN A TERTIARY HOSPITAL MICU: A QUALITY IMPROVEMENT INITIATIVE

2021 ◽  
Vol 50 (1) ◽  
pp. 615-615
Author(s):  
Srdjan Gajic ◽  
Steven Gudowski ◽  
Stephanie Maillie ◽  
Megan Lucas ◽  
Marya Lieb ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Tertiary Hospital ◽  
Quality Improvement Initiative
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