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Improving Efficiency and Communication around Sedated Fracture Reductions in a Pediatric Emergency Department

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 lon...

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Detalles Bibliográficos
Autores principales: Paydar-Darian, Niloufar, Goldman, Michael P., Michelson, Kenneth A., Button, Katharine C., Hewett, Elizabeth K., Macnow, Theodore E., Miller, Andrew F., Musisca, Megan A., Hudgins, Joel D., Eisenberg, Matthew A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426494/
https://www.ncbi.nlm.nih.gov/pubmed/30937415
http://dx.doi.org/10.1097/pq9.0000000000000135
Descripción
Sumario: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.