Quality Improvement Methodology Research Articles

Enhancing Wellbeing in Emergency Department Allied Health Care Coordinators: A Multifaceted Intervention Approach

This practice note outlines a structured, team-based intervention to address clinician burnout within a metropolitan Care Coordination team within one health organisation. This twelve-month project (April 2023–2024) was implemented in collaboration with Safer Care Victoria (SCV), utilising the Institute of Healthcare Improvement’s (IHI) Joy in Work (JIW) framework aiming to improve clinician wellbeing and burnout. Strategies included a wellbeing survey adapted from the Mini Z survey, What Matters to You (WMTY) clinician interviews, and the impact-effort matrix prioritisation tool. This approach targeted burnout drivers and establish a sustainable framework for employee support by emphasising feedback, high-impact interventions, and resilience through collaboration. Targeted interventions like reviewing orientation documents, team learning sessions, and updating clinical resources led to a decrease in the team’s mean Mini Z, scores of perceived burnout. Challenges during implementation highlighted the need for a toolkit to support this project in other settings where knowledge of quality improvement methodology may be limited. The initiative established a potential replicable model for addressing burnout, though its broader effectiveness remains under evaluation.

Utilizing Quality Improvement Methodology to Address Disparities in Colorectal Cancer Screening Between Faculty and Resident Physicians.

Health system data from a large academic medical center revealed a 14% lower rate of colorectal cancer (CRC) screening in resident patient panels compared to faculty patient panels. This resident-led quality improvement (QI) work identified causes for disparities in CRC screening and implemented an innovative panel management intervention to reduce CRC screening disparities. Analysis was conducted across two academic primary care clinics at a single institution. Residents engaged key stakeholders in the CRC screening process to identify causes for disparities and potential solutions in the CRC screening process. A novel interprofessional panel management protocol was implemented to guide residents on how to perform population health strategies to increase CRC screening and to streamline the navigation process. The effectiveness of each intervention in improving CRC screening was analyzed. After four months of protocol implementation, CRC screening for resident patient panels improved from 62 to 68% based on analysis done on a run chart. The difference in CRC screening between faculty and resident patient panels decreased from 14 to 10%, reducing the disparity by 29%. This interprofessional panel management protocol significantly increased the CRC screening rates among patients receiving primary care from resident physicians. This further highlights the importance of multipronged interventions to improve disparities in CRC screening and to improve overall screening rates.

Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit.

Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions. A multidisciplinary team developed a key driver diagram to identify areas for focused intervention. Each plan-do-study-act cycle informed the next cycle of interventions, targeting increasing interpreter (video, phone, and in-person) use. Interventions included standardizing technology, standardizing placement of interpretation devices in patient rooms, provider education, and creating accountability systems of interpreter use by care providers. We reviewed data from PICU encounters between January 2018 and January 2022 and used summary statistics and statistical process control methods to measure the impact of our interventions. We analyzed 882 patient encounters over the 4-year study period. Demographic characteristics were similar in the preintervention and postintervention periods. The total interpretation rate increased to 2.7 interpretations per patient per day from a baseline rate of 1.4. Each individual interpretation modality demonstrated increases in use. Average time spent interpreting via phone increased from 8 to 10.5 minutes per patient per day, and average time spent interpreting via video went from 9.5 to 22 minutes per patient per day. Iterative quality improvement methodology effectively identified barriers to equitable care, guided development of focused interventions, and improved interpreter use among pediatric patients who were critically ill.

Results of a healthcare transition learning collaborative for emerging adults with sickle cell disease: the ST3P-UP study transition quality improvement collaborative

BackgroundIndividuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative...

Assessing the Critical Factors Leading to the Failure of the Industrial Pressure Relief Valve Through a Hybrid MCDM-FMEA Approach

Industrial pressure relief valves must function reliably and effectively to protect pressurized systems from excessive pressure conditions. These valves are essential safety devices that act as cushions to protect piping systems, equipment, and vessels from the risks of high pressure, which can cause damage or even explosions. The objectives of this study were to minimize valve failures, decrease the number of rejected valves in the production line, and enhance the overall quality of pressure relief valves. This work introduces an integrated quality improvement methodology known as the hybrid multi-criteria decision-making (MCDM)—failure mode and effects analysis (FMEA) approach. This approach is based on prioritizing crucial factors for any failure modes in the industrial setting. The presented case study demonstrates the application of a hybrid approach for identifying the fundamental causes of industrial pressure relief valve failure modes and malfunctions. This investigation highlights the applicability of FMEA as a methodology for determining causes and executing remedial actions to keep failures from happening again. FMEA helps uncover the underlying causes of industrial pressure relief valve failures, while the integration of the hybrid MCDM methodology enables the application of four integrated MCDM methods to identify crucial factors. The adopted model addresses the shortcomings of the conventional FMEA by accurately analyzing the relationships between the risk factors and by utilizing several MCDM methods to rank failure modes. Following the application of the adopted methodology, it was discovered that the high-risk failure modes for the pressure relief valve included misalignment of wire, normal wear/aging, rejection of machined parts, mismatch of mating parts, and corrosion. Therefore, risk managers should prioritize developing improvement strategies for these five failure modes. Similarly, failures comprising debris, delayed valve opening, internal leakage, premature valve opening, and burr foreign particles were determined as second essential groups for improvement.

The feasibility of a novel national quality improvement programme for tobacco dependency treatment pathways in acute UK hospitals

IntroductionThe prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands.This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. MethodsThe programme utilised the Model for Improvement as its QI framework and was delivered over a 6-month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways. ResultsResults of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence and attitudes along with enhanced project management skills. ConclusionThis novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.

Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care.

Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (>5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics.

Improving the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway using quality improvement methodology

BackgroundThe National Institute for Health and Care Excellence (NICE) guideline quality standard for non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway states that adults who have an intermediate or higher risk...

Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.

The Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer. Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events. After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement. As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.

Multifactorial fall interventions for people over 65 years in the acute hospital setting: pre–post-test design

Background: Falls are the most reported patient safety incident for patients >65 years in acute hospital settings worldwide. While multifactorial fall interventions reduce the number of falls in subacute and rehabilitation settings, fall interventions in acute hospital settings are unknown. Aim: To evaluate the effectiveness of multifactorial fall interventions on the number of falls using codesigned education targeting staff and the patient and review the environment in acute hospital settings in NSW, Australia for patients over 65 years of age. Method: A pre–post-test design with a non-equivalent group was conducted. All acute hospital inpatient falls occurring both pre- and post-intervention within one health district were included in this study. The use of Quality Improvement methodology identified gaps in risk screening and assessment, education and information, communication of risk, and standardised fall prevention equipment. Codesigned interventions to address these gaps were undertaken. Results: The number of falls (p = 0.038) and injurious falls (p < 0.001) significantly decreased in the post-intervention group. There was a significant improvement in fall assessments (p < 0.001), delirium risk screening (p < 0.001), the provision of fall information (p < 0.001) and fall risk discussed at shift handover (p < 0.001) in the post-intervention group. Following the intervention, staff were significantly more likely to undertake fall education modules (p < 0.001) and develop a fall management plan (p < 0.001). Conclusion: Falls continue to have a significant economic impact on the acute hospital setting. Our findings highlight multifactorial fall interventions that included staff and patients in the development phases reduced the number of falls. Multifactorial fall interventions targeting staff, patients and the environment may influence a reduction in the number of falls and the severity of falls in the acute hospital setting.

Implementing Screening for Neonatal Delirium in the Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Delirium is not commonly diagnosed in neonatal intensive care units and can adversely impact patient outcomes in the ICU setting. Recognition of delirium in the NICU is a necessary first step to address the potential impact on neonatal outcomes. We conducted a quality improvement initiative implementing screening for neonatal delirium. We aimed to increase screening in NICU patients from 0% to 85% by March 2022. Interdisciplinary meetings were held with key stakeholders to develop a clinical algorithm. We used standardized tools for delirium screening. Our process measures included weekly nursing compliance with Richmond Agitation Sedation Scale/Cornell Assessment of Pediatric Delirium/ scoring documentation (Fig. 1) and patients referred to psychiatry. Outcome measures included the percentage of patients screened for delirium before discharge. We conducted Plan-Do-Study Act cycles to optimize the screening process in the electronic medical record (EMR). This included creating an order set, documentation flowsheets, and prompts in the EMR for patients. After initial implementation, we achieved an average weekly screening compliance of 76% (Fig. 1). Inclusion criteria expansion resulted in a downward compliance shift to 59%. Subsequently, the addition of the EMR checklist resulted in a center-line shift to a sustained average weekly screening compliance of 77%. An average of 82% of all eligible NICU patients received delirium screening before discharge (Fig. 2). Using quality improvement methodology, there was increased screening and recognition of delirium in our NICU. Future research efforts could focus on assessing preventive measures and the impact of neonatal delirium on patient outcomes.

Aligning with Obesity Guidelines: A Quality Improvement Initiative in Pediatric Primary Care

ObjectiveNational guidelines recommend diagnosis of obesity based on Body Mass Index (BMI) starting at age 2 and screening for specific comorbidities based on age and risk factors. A multi-modal intervention was developed and quality improvement (QI) methodology was used to assess the effectiveness of different interventions on pediatric primary care clinician’s adherence to evidence based clinical guidelines. Study DesignA multidisciplinary team was engaged to develop an institutional weight management and diet related disease toolkit to standardize practice through a (QI) initiative. This initiative included an educational series, coaching sessions for a subset of providers, and automating Electronic Medical Record (EMR) changes to support adherence to the clinical toolkit. We staggered the interventions to assess for behavior change related to clinical documentation and lab ordering practices. ResultsBaseline data showed significant differences between individual clinicians’ practices. Educational initiatives increased the use of diagnostic obesity codes from a baseline of <20% to >75% of charts. Initially International Classification of Diseases (ICD)-10 codes for nutrition and physical activity counseling were under-utilized and remained low despite education interventions. EMR prompts and templates led to a significant and sustained increase in coding. A statistically significant decrease in overall extraneous lab collection was noted but inconsistencies in lab collection persisted. ConclusionThis QI initiative aimed to standardize clinicians’ behavior around EMR documentation. A multimodal intervention was able to improve documentation of weight status and counseling measures to >80% of well child check (WCC) encounters. Future studies are encouraged to investigate if these changes led to improved patient outcomes.

Measuring Improvement Capabilities in a Health System: Findings From a Content Validity Study

Measurable improvements in the American Healthcare System have been elusive. To understand why, a survey measuring improvement capabilities in a health system was developed from a 2002 tool that measured an outdated quality improvement methodology. That survey was tested for content validity and achieved an overall representativeness content validity index of 87.5%. From the responses and discussions with the subject matter experts, 3 reasons emerged as to why a lack of improvement occurs in key metrics on a balanced scorecard. These 3 were the decentralization of improvement efforts, waning leadership attention, and presenting information rather than insights.

Cardiac rehabilitation ambassadors - a new model to enhance patient participation

Abstract Introduction Participation in outpatient Cardiac Rehabilitation (CR) is considered an integral part of secondary treatment of heart disease. Despite being considered standard care, participation remains low internationally. Encouraging patients to enrol in CR during their hospital stay is linked to higher participation. [1] This study was conducted at a hospital that provides acute cardiac and rehabilitation services in Australia. Purpose As a provider of cardiac care, we identified that increasing nurses’ knowledge of the of CR would improve their capacity to promote CR during patient’s hospital stay. Methods Utilising a quality improvement methodology, the Cardiac Ambassador Initiative was developed with key stakeholders working on cardiac units in 2022. The program consisted of an immersion experience for cardiac nurses to shadow CR nurses working in a specialist rehabilitation centre providing best practice CR for patients with a variety of cardiac conditions. To evaluate the impact of the program, cross-sectional surveys and individual interviews were conducted with participants and Nurse-Unit-Managers (NUMs). Key outcomes included: ambassadors’ knowledge and confidence to promote CR participation to their patients on the wards and NUM's perceptions of the impact of the program. Results The program was run over two years. The NUMs and CR-coordinator selected a total of 13 nurses to participate. In 2022 4 participants attended a total of 5 days each. Following evaluation, the program was modified to 3 days for participants in 2023, which enabled 9 participants to attend. All participants described not fully understanding the nature of CR and its impact on patients until they attended a program. Prior to attendance, 100% of participants considered it was important or somewhat important for patients to attend CR. Following attendance 100% of participants consider it essential or important for patients to attend. They also reported feeling more confident to discuss CR with patients and colleagues and encourage patient participation following the immersion experience. Pre-attendance 100% of participants felt either not at all confident or somewhat confident to discuss CR with their patients and this improved post program with 100% feeling very confident. 100% of participants also indicated that their confidence and skill in discussing CR with patients greatly improved and recommended that others should participate in the CR Ambassador program. Nurse Unit Managers reported that the CR Ambassadors were a valuable resource for both staff and patients on the cardiac unit and that they had identified a need to review the accessibility of CR information and referral documentation available on their wards. Conclusion The immersion experience represents a feasible and sustainable approach to establishing CR ambassadors on acute cardiac wards with the skills needed to promote CR participation to colleagues and patients.

Implementation Strategies Used to Reduce UEs in the Neonatal Intensive Care Unit.

Unplanned extubation (UE) is the premature or unintended removal of an artificial airway and can cause worse patient outcomes. Study objectives were to describe implementation strategies used to reduce UE in the Hospital for Sick Children neonatal ICU (NICU) and their influence on UE rates, and contributing factors and patient characteristics of infants who had an UE, and compare them between the biological sexes. We hypothesized that the boys would experience more UEs and worse outcomes compared to the girls. The single-center retrospective cohort study included all infants who experienced UE (2007-2019). Outcomes consisted of implementation reduction strategies developed by using the plan-do-study-act quality-improvement methodology and UE characteristics, including patient (eg, sex, length of stay) and unplanned extubation situation characteristics (eg, events and/or procedures, repeats). Five plan-do-study-act cycles were implemented. Analyses included text summaries of all strategies, and quantitative descriptive and comparative statistics. UE per 100 ventilator days decreased from 3.46 to 0.14. Key success factors included setting achievable goals; ensuring that strategies were evaluated and amended; maintaining consistency over the long-term; incorporating strategies in the NICU; having institutional support and validation; and having good communication. There were 302 UE in 257 infants, 141 boys (55%), average ± SD gestational age of 31 ± 6 weeks, and 31 (12%) had 45 repeated UEs. The only significant difference between the biological sexes was that more boys (129 [92%]) versus girls (94 [83%]) received the Hospital for Sick Children NICU endotracheal tube taping protocol (P = .030). The incidence of UE occurred in a 2-peaked pattern, highest for those < 32 weeks and ≥ 32 weeks of gestational age. Infants < 32 weeks of gestational age and with repeated UE had longer durations of invasive mechanical ventilation and length of stay. For infants <32 versus => 32 weeks gestational age, the median (interquartile range) duration of mechanical ventilation was 38 (16-77) d versus 6 (3-13) d and hospital length of stay 61 (30-100) d versus 16 (10-41) d. For infants with repeated versus no repeated unplanned extubations, duration of mechanical ventilation was 69 (26-125) d versus 13 (4-52) d and hospital length of stay 90 (39-137) d versus 32 (12-75) d. Detailed well-planned UE reduction strategies significantly reduced the rate of UEs with key factors of success identified. UE characteristics and infant morbidity did not differ between the biological sexes. Infants < 32 weeks of gestational age and with repeated UE had a longer duration of mechanical ventilation and length of stay.

Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project.

This patient safety and quality improvement report outlines the successful reduction of catheter-associated urinary tract infections (CAUTI) through a comprehensive interdisciplinary team approach. It emphasizes the implementation of best practices and the involvement of both patients and their families in catheter care. The project was conducted at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East, with 511 beds and over 20 inpatient units. The primary objective of this project was to assess gaps in current CAUTI prevention practices and implement effective strategies to reduce infection rates. By adopting quality improvement methodologies from the Institute of Healthcare Improvement (IHI) and the Deming Four-Stage Cycle, the aim was to prevent CAUTIs and improve patient safety and clinical outcomes. Urinary catheters, commonly used for patients with neurogenic bladder dysfunction and sacral deep pressure injuries, posed a high risk of infection, with a daily infection risk of 3-7%. Despite available preventive measures, the facility experienced a high average CAUTI rate of 1.28/1000 catheter daysfrom 2021 to mid-2023. This project involved the systematic identification of gaps, the adoption of evidence-based practices, and the engagement of healthcare staff, patients, and families in rigorous CAUTI prevention efforts. The project resulted in a significant reduction in the CAUTI rate, decreasing from 1.28 infections per 1000 catheter days pre-intervention to 0.42 infections per 1000 catheter days post-intervention. This improvement highlights the effectiveness of collaborative efforts and evidence-based interventions in controlling and preventing CAUTIs. The findings of this project demonstrate that CAUTI prevention is achievable through a coordinated approach involving healthcare providers, strong evidence-based interventions, and the active participation of patients and families. This collaborative model led to better patient safety outcomes and significantly reduced CAUTI rates, showing the importance of comprehensive care strategies in mitigating preventable patient harm.

Impact of Applying PDCA Circulation Method on Surgical Care Interventions in the Operating Room on Patients Undergoing Cardiothoracic Surgery: A Retrospective Study

Background: The Plan-Do-Check-Act (PDCA) cycle is a widely recognized methodology for continuous quality improvement. This study evaluated the impact of applying the PDCA cycle on surgical care interventions in the operating room for patients undergoing cardiothoracic surgery. Methods: A retrospective study was conducted on the treatment of patients who underwent continuous cardiothoracic surgery in our Hospital from July 2020 to June 2023. Participants were divided into control and PDCA groups on the basis of the application of the PDCA cycle in their surgical care. Various outcomes were assessed, including psychological well-being (Hospital Anxiety and Depression Scale [HAMA] and Hamilton Depression Rating Scale [HAMD] scales), quality of life (using the QLQ-C30 tool), patient satisfaction, incidence of adverse accidents, clinical parameters, and laboratory measures. Results: The study comprised 133 patients, with 62 in the control group and 71 in the PDCA group. The psychological well-being, as measured by the HAMA and HAMD scales, of the PDCA group showed significant improvements compared with that of the control group (p &lt; 0.05). The Quality-of-Life scores were higher in the PDCA group than in the control group (p &lt; 0.05). In the PDCA group, the patient satisfaction scores related to hospital satisfaction were significantly higher than that in the control group, and the incidence of adverse accidents was lower (all p &lt; 0.05). No significant differences were noted in clinical parameters (ejection fraction and B-type natriuretic peptide levels) nor laboratory measures (serum protein and C-reactive protein (CRP) levels) between the groups (p &gt; 0.05 for all). Conclusion: The implementation of the PDCA cycle in the operating room for patients undergoing cardiothoracic surgery significantly improved psychological well-being and patient satisfaction and reduced the incidence of adverse accidents in the operating room, indicating that this quality improvement approach can enhance patient care experience. Although no significant differences were observed in clinical and laboratory parameters, the findings suggest that the PDCA cycle's strengths lie in its systematic approach to care process optimization and patient-centered outcomes.

Automated mental health screening in pediatric lupus: associations with disease features and treatment.

Patients with childhood-onset systemic lupus erythematosus (c-SLE) have higher rates of depression than their peers, which has been associated with worse medical outcomes. Therefore, it is imperative that their mental health be addressed. We utilized quality improvement (QI) methodology to automate mental health screening for patients with lupus within a pediatric rheumatology clinic. The retrospective cohort study aims to evaluate the association between mental health screening outcomes and demographics, medications, and disease activity measures in patients with childhood lupus. The mental health QI team at a quaternary pediatric rheumatology center implemented an automated process for mental health screening in patients with c-SLE. Patients seen between 2017 and June 2023 with a diagnosis of c-SLE were identified using International Classification of Disease -Clinical Modification (ICD-CM) codes. Disease activity was assessed with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K). Medications were identified on outpatient and inpatient orders for conventional synthetic and biologic disease-modifying anti-rheumatic drugs, hydroxychloroquine, corticosteroids, and aspirin. Mental health screening was accomplished with the Patient Health Questionnaire (PHQ). Descriptive statistics, univariate and multivariate linear regression were used. Between January 2017 and June 2023, 117 patients with c-SLE (41% with lupus nephritis) completed 534 total screenings. Each patient completed PHQ screenings, a median of 5 [interquartile range 2, 6] times. Screening increased when the screening process was automated. Those who were Black, female, or prescribed leflunomide, mycophenolate, and corticosteroids had higher PHQ scores. Mental health support is essential for patients with chronic rheumatologic diseases such as SLE. Sustainable processes for quickly identifying depression are needed for optimal care of patients with SLE. Our process of automated, streamlined mental health screening successfully increased the screening of patients with SLE at every visit and led to timely interventions for positive PHQ scores. Higher PHQ scores were correlated with patients on leflunomide, mycophenolate, and corticosteroids. Future research should identify modifiable risk factors for high PHQ scores that the medical team can target.

A quality improvement initiative to reduce excess inhaled therapy use in the neonatal intensive care unit.

Inhaled medications are commonly used at our single-center, Level IV neonatal intensive care unit (NICU). We lacked a standardized process for measuring efficacy of these medications to guide optimal duration of use, potentially leading to their overuse. We utilized quality improvement methodology to reduce the length of inhaled hypertonic saline (HTS) course durations and high frequency albuterol use. Interventions included education, data sharing, and implementation of a respiratory therapy assessment tool. The average inhaled HTS course duration decreased from 8.7 to 4.2 days. The percentage of q4 albuterol administrations per total albuterol doses administered monthly decreased from 39 to 20%. Developing a shared mental model between interprofessional providers for the indication and effect of inhaled agents and standardizing assessment of these medications' efficacy can reduce their overuse.

Standardizing the evaluation and management of iron deficiency anemia secondary to heavy menstrual bleeding in the emergency department.

Comprehensive guidelines for the management of iron deficiency anemia (IDA) in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize the evaluation and management of these patients through the development and implementation of an evidence-based algorithm using quality improvement methodology. Baseline data of the target population identified variability across four key measures of clinical management: therapy choice and administration, laboratory evaluation, hematology service consultation, and patient disposition. Literature review and consensus from pediatric hematology and gynecology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From December 2022 to July 2023, we aimed to achieve a 25% relative increase in patients to receive optimal management per the algorithm, while using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider documentation and balancing measures, such as ED length of stay, were assessed concurrently. Forty-nine patients were evaluated during four PDSA cycles. Improvement of ≥40% above baseline regarding recommended therapy administration was achieved across four PDSA cycles. Adherence to recommended therapy choice improved from 57% (baseline) to 100%, minimal laboratory evaluation from 14% to 83%, hematology consultation from 36% to 100%, and appropriate disposition from 71% to 100%. ED length of stay remained stable. Implementation of a standardized algorithm for management of IDA secondary to HMB in adolescents in the ED increased adherence to evidence-based patient care.