Improving Efficiency and Communication around Sedated Fracture Reductions in a Pediatric Emergency Department
Authors
Paydar-Darian, NiloufarGoldman, Michael P.
Michelson, Kenneth A.
Button, Katharine C.
Hewett, Elizabeth K.
Macnow, Theodore
Miller, Andrew F.
Musisca, Megan A.
Hudgins, Joel D.
Eisenberg, Matthew A.
UMass Chan Affiliations
University of Massachusetts Memorial Children's Medical CenterDivision of Pediatric Emergency Medicine, Department of Pediatrics
Document Type
Journal ArticlePublication Date
2019-02-13Keywords
pediatricsemergency department
sedation
fractures
Emergency Medicine
Health Communication
Health Services Administration
Health Services Research
Pediatrics
Metadata
Show full item recordAbstract
Introduction: Procedural sedation for fracture reduction in the pediatric emergency department (ED) is a time-consuming process requiring multidisciplinary coordination. We implemented a quality improvement initiative aimed at (1) decreasing mean ED length of stay (LOS) for children with sedated long bone fracture reductions by 15% over 12 months and (2) improving interdisciplinary communication around procedural sedation. Methods: Pediatric emergency medicine fellows at a children's hospital designed and implemented an initiative targeting the efficiency of the sedation process. Interventions included a centralized sedation tracking board, a team member responsibility checklist, family handouts, early discharge initiatives, and postsedation review forms. We tracked progress via statistical process control charts and interdisciplinary communication by intermittent surveys. Results: Pediatric emergency medicine fellows performed 2,246 sedations during the study period. Mean LOS decreased from 361 to 340 minutes (5.8%) after implementation and demonstrated sustainability over the postintervention period. One hundred eight providers completed the preimplementation communication survey, with 58 and 64 completing surveys at 4 and 9 months postimplementation, respectively. The proportion reporting somewhat or strong satisfaction with communication increased from 68% at baseline to 86% at 4 months (P = 0.02) and 92% at 9 months (P < 0.001 versus baseline). Conclusions: A quality improvement initiative created a sustainable process to reduce ED LOS for sedated reductions while improving satisfaction with interdisciplinary communication.Source
Pediatr Qual Saf. 2019 Feb 13;4(1):e135. doi: 10.1097/pq9.0000000000000135. eCollection 2019 Jan-Feb. Link to article on publisher's site
DOI
10.1097/pq9.0000000000000135Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43682PubMed ID
30937415Related Resources
Rights
Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Distribution License
http://creativecommons.org/licenses/by/4.0/ae974a485f413a2113503eed53cd6c53
10.1097/pq9.0000000000000135
Scopus Count
Except where otherwise noted, this item's license is described as Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.