A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting
| Autor: | William Lynders, Syed A. Jamal Bokhari, Michael Crain, Michael P. Goldman, Daniel M. Solomon, Gunjan Tiyyagura, Beth L. Emerson, Marc Auerbach, Mariann Nocera Kelley |
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| Rok vydání: | 2021 |
| Předmět: |
Teamwork
medicine.medical_specialty Quality management business.industry media_common.quotation_subject Psychological intervention Multi-institutional collaborative and QI network research Community hospital Community of practice Clinical pathway Family medicine General partnership ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Medicine business Baseline (configuration management) media_common |
| Zdroj: | Pediatric Quality & Safety |
| ISSN: | 2472-0054 |
| Popis: | Supplemental Digital Content is available in the text. Introduction: 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. |
| Databáze: | OpenAIRE |
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