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A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting
The primary aim of this quality improvement initiative was to decrease the use of computerized tomography (CT) in the evaluation of pediatric appendicitis in a community general emergency department (GED) system by 50% (from 32% to 16%) in 1 year. METHODS: Colleagues within a State Emergency Medical...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476057/ https://www.ncbi.nlm.nih.gov/pubmed/34589653 http://dx.doi.org/10.1097/pq9.0000000000000479 |
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author | Goldman, Michael P. Lynders, William Crain, Michael Nocera Kelley, Mariann Solomon, Daniel M. Bokhari, Syed A.J. Tiyyagura, Gunjan Auerbach, Marc A. Emerson, Beth L. |
author_facet | Goldman, Michael P. Lynders, William Crain, Michael Nocera Kelley, Mariann Solomon, Daniel M. Bokhari, Syed A.J. Tiyyagura, Gunjan Auerbach, Marc A. Emerson, Beth L. |
author_sort | Goldman, Michael P. |
collection | PubMed |
description | The primary aim of this quality improvement initiative was to decrease the use of computerized tomography (CT) in the evaluation of pediatric appendicitis in a community general emergency department (GED) system by 50% (from 32% to 16%) in 1 year. METHODS: Colleagues within a State Emergency Medical Service for Children (EMSC) community of practice formed the quality improvement team, representing multiple stakeholders across 3 independent institutions. The team generated project aims by reviewing baseline practice trends and implemented changes using the Model for Improvement. Ultrasound (US) use and nondiagnostic US rates served as process measures. Transfer and “over-transfer” rates served as balancing measures. Interventions included a GED pediatric appendicitis clinical pathway, US report templates, and case audit and feedback. Statistical process control tracked the main outcomes. Additionally, frontline GED providers shared perceptions of knowledge gains, practice changes, and teamwork. RESULTS: The 12-month baseline revealed a GED CT scan rate of 32%, a US rate of 63%, a nondiagnostic US rate of 77%, a transfer to a children’s hospital rate of 23.5%, and an “over-transfer” rate of 0%. Project interventions achieved and sustained the primary aim by decreasing the CT scan rate to 4.5%. Frontline GED providers reported positive perceptions of knowledge gains and standardization of practice. CONCLUSIONS: Engaging regional colleagues in a pediatric-specific quality improvement initiative significantly decreased CT scan use in children cared for in a community GED system. The emphasis on the community of practice facilitated by Emergency Medical Service for Children may guide future improvement work in the state and beyond. |
format | Online Article Text |
id | pubmed-8476057 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-84760572021-09-28 A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting Goldman, Michael P. Lynders, William Crain, Michael Nocera Kelley, Mariann Solomon, Daniel M. Bokhari, Syed A.J. Tiyyagura, Gunjan Auerbach, Marc A. Emerson, Beth L. Pediatr Qual Saf Multi-institutional collaborative and QI network research The primary aim of this quality improvement initiative was to decrease the use of computerized tomography (CT) in the evaluation of pediatric appendicitis in a community general emergency department (GED) system by 50% (from 32% to 16%) in 1 year. METHODS: Colleagues within a State Emergency Medical Service for Children (EMSC) community of practice formed the quality improvement team, representing multiple stakeholders across 3 independent institutions. The team generated project aims by reviewing baseline practice trends and implemented changes using the Model for Improvement. Ultrasound (US) use and nondiagnostic US rates served as process measures. Transfer and “over-transfer” rates served as balancing measures. Interventions included a GED pediatric appendicitis clinical pathway, US report templates, and case audit and feedback. Statistical process control tracked the main outcomes. Additionally, frontline GED providers shared perceptions of knowledge gains, practice changes, and teamwork. RESULTS: The 12-month baseline revealed a GED CT scan rate of 32%, a US rate of 63%, a nondiagnostic US rate of 77%, a transfer to a children’s hospital rate of 23.5%, and an “over-transfer” rate of 0%. Project interventions achieved and sustained the primary aim by decreasing the CT scan rate to 4.5%. Frontline GED providers reported positive perceptions of knowledge gains and standardization of practice. CONCLUSIONS: Engaging regional colleagues in a pediatric-specific quality improvement initiative significantly decreased CT scan use in children cared for in a community GED system. The emphasis on the community of practice facilitated by Emergency Medical Service for Children may guide future improvement work in the state and beyond. Lippincott Williams & Wilkins 2021-09-24 /pmc/articles/PMC8476057/ /pubmed/34589653 http://dx.doi.org/10.1097/pq9.0000000000000479 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Multi-institutional collaborative and QI network research Goldman, Michael P. Lynders, William Crain, Michael Nocera Kelley, Mariann Solomon, Daniel M. Bokhari, Syed A.J. Tiyyagura, Gunjan Auerbach, Marc A. Emerson, Beth L. A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title | A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title_full | A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title_fullStr | A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title_full_unstemmed | A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title_short | A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting |
title_sort | qi partnership to decrease ct use for pediatric appendicitis in the community hospital setting |
topic | Multi-institutional collaborative and QI network research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476057/ https://www.ncbi.nlm.nih.gov/pubmed/34589653 http://dx.doi.org/10.1097/pq9.0000000000000479 |
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