Improving Care and Outcomes for Pediatric Musculoskeletal Infections.
| Autor: | Hester GZ; Departments of Quality, gabrielle.hester@childrensmn.org., Nickel AJ; Research Institute, Children's Minnesota, Minneapolis, Minnesota; and., Watson D; Research Institute, Children's Minnesota, Minneapolis, Minnesota; and., Swanson G; Hospital Medicine., Laine JC; Orthopedic Surgery, and.; Gillette Children's Specialty Healthcare, St Paul, Minnesota., Bergmann KR; Emergency Medicine and. |
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| Jazyk: | angličtina |
| Zdroj: | Pediatrics [Pediatrics] 2021 Feb; Vol. 147 (2). Date of Electronic Publication: 2021 Jan 07. |
| DOI: | 10.1542/peds.2020-0118 |
| Abstrakt: | Background: Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration. Methods: We implemented 4 prospective QI interventions at our tertiary children's hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015-October 17, 2016) and implementation (October 18, 2016-April 2019). Results: In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%-11%; 95% confidence interval 70-92) and 33% relative reduction in sedations per patient (centerline shift 1.8-1.2; 95% confidence interval 21-46). Empirical vancomycin use did not change (centerline 20%). Conclusions: Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.) |
| Databáze: | MEDLINE |
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