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Pediatr Qual Saf. 2019 Feb 13;4(1):e135. doi: 10.1097/pq9.0000000000000135. eCollection 2019 Jan-Feb.

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

Author information

1
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
2
Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Conn.
3
Division of Emergency Medicine, Children's National Medical Center, Wash.
4
Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
5
Division of Pediatric Emergency Medicine, University of Massachusetts Memorial Children's Medical Center, Worcester, Mass.

Abstract

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.

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