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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.

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



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.


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.


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).


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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