Use Of Quality Improvement Methodology Research Articles

Implementation of a Patient-Reported Outcome Measure: A Quality Improvement Project.

Patient-reported outcome measures (PROMs) are seen as increasingly beneficial to patient-centered clinical practice, but implementation of routine collection and utilization into clinical care can be challenging. Our interdisciplinary quality improvement (QI) team used the Institute for Health Care Improvement Model for Improvement methodology to address this problem in our outpatient neurorehabilitation program. We used a participatory approach to identify the PROM rehabilitation stakeholders found to be most appropriate to implement in the outpatient settings; chart audits were conducted to determine the extent to which clinicians implemented the PROM and documented a PROM-related goal. Opportunistic clinician feedback was collected to determine single PROM usefulness and acceptability. Our 4-month initiative demonstrated increased collection of a PROM, the Patient-Specific Functional Scale (PSFS), and incorporation into patient-centered goal. Use of QI methodology was beneficial when planning and executing our initiative. Future work is needed to examine factors to sustain PSFS use, incorporation into patient-centered goal setting, and maximize meaningful patient outcomes.

Approaches to starting and growing ERAS at a Children's Hospital

Enhanced Recovery After Surgery is a multi-disciplinary, multi-modal, evidence-based approach to perioperative care that is known to improve outcomes for adult patients and has more recently been shown to lead to similar improvements for children. Its success in adult patients has led to growing interest in the adoption of ERAS in the pediatric population. Successful ERAS implementation hinges on strong leadership, provider and patient education and engagement, and continuous audit with the use of quality improvement methodology. The electronic health record is an invaluable tool that can be leveraged to not only aid in delivering standardized care through order sets for medications, fluids, and daily cares, but also to document and audit process measures and outcomes. In this paper, the authors describe our 10-year journey at a free-standing children's hospital from initial “baby steps” implementing individual elements for a single surgery to 11 active, comprehensive protocols spanning eight specialties and growing.

Use of statistical process control in quality improvement projects in abdominal surgery: a PRISMA systematic review

BackgroundThe use of quality improvement methodology has increased in recent years due to a perceived benefit in effectively reducing morbidity, mortality and length of stay. Statistical process control (SPC) is...

Enhancement and Implementation of a Health Information Technology Module to Improve the Discrete Capture of Cancer Staging in a Diverse Regional Health System.

Cancer staging is the foundation for all cancer management decisions. For real-time use, stage must be embedded in the electronic health record as a discrete data element. The objectives of this quality improvement (QI) initiative were to (1) identify barriers to utilization of an existing discrete cancer staging module, (2) identify health information technology (HIT) solutions to support discrete capture of cancer staging data, and (3) increase capture across the oncology enterprise in our diverse health system. Six sigma QI methodologies were used to define barriers and solutions to improve discrete cancer staging. Design thinking principles informed solution development to test prototypes. Two multidisciplinary teams of disease-specific clinicians within GI and genitourinary conducted phased testing pilots to determine health system solutions. Solutions were expanded to all oncology specialties across our health system. Baseline average discrete staging capture across our health system was 31%. Poor workflow efficiency, limited accountability, and technical design gaps were key barriers to timely, complete staging. Implementation of more than 25 design enhancements to a HIT solution and passive user alerts led to a postimplementation capture rate of 58% across 55 outpatient clinics involving more than 400 clinicians. We identified key barriers to discrete data capture and designed solutions through iterative use of QI methodologies and disease-specific pilots. After implementation, discrete capture of cancer staging nearly doubled across our diverse health system. This approach is scalable and transferable to other initiatives to develop and implement clinically relevant HIT solutions across a diverse health system.

Use of quality improvement methodology to improve on differentiated service delivery through decentralized drug distribution; Dumisha Afya project

Use of quality improvement methodology to improve on differentiated service delivery through decentralized drug distribution; Dumisha Afya project

Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative

ObjectiveTo describe the use of quality improvement methodology in transitioning from delivery of surfactant by INSURE (INtubation–SURfactant administration–Extubation) to video laryngoscope-assisted LISA (less-invasive surfactant administration) for infants with respiratory distress...

Curricular Revision to Increase Use of Quality Improvement Principles in Doctor of Nursing Practice Projects

BackgroundA gap was identified related to students’ use of quality improvement (QI) methodologies in their final project, so a curricular change was made to incorporate a health care QI methods course in the curriculum. MethodsWe compared the use of SMART (specific, measurable, achievable, relevant, and time-bound) aims and QI evaluation methodologies in doctor of nursing practice (DNP) project proposals in 2 cohorts before and after the curriculum change. ResultsA total of 88 DNP proposals were evaluated. ConclusionIncluding a QI course increased the use of SMART aims but did not influence the use of QI methodologies. Future interventions will target faculty development related to QI.

Proactive use of QI methodology in consultation-liaison psychiatry to support the opening of a new COVID+ behavioral health inpatient unit during the omicron surge

Inpatient consultation-liaison (CL) psychiatry teams routinely facilitate the transfer of medically stable patients in behavioral health crisis from the general hospital to inpatient psychiatric units. The COVID-19 pandemic had a significant impact on this process when inpatient psychiatric units were unable to provide care for patients with asymptomatic COVID-19 infection because of infection control concerns in units unable to accommodate isolation precautions. Similar to other disrupted hospital workflows, these clinical handoffs became more complicated by requiring COVID exposed or COVID+ patients in the midst of behavioral health crisis to quarantine or isolate on general hospital units if not otherwise stable for discharge to the community. To better respond to the growing number of patients isolating in the general hospital during the 2022 Omicron surge, we used quality improvement (QI) methodology to illustrate the need to create a COVID+ unit in the inpatient psychiatric hospital to care for the growing cohort of COVID+ patients in psychiatric crisis who were otherwise unable to access traditional psychiatric hospital care because of their isolation status.

Use of quality improvement methodology to improve care of women with hypertensive disease in pregnancy and haemorrhage in Yemen (low-income, high-insecurity setting)

This safety improvement project used quality improvement methods in a Comprehensive Emergency Obstetric and Newborn Care facility in Yemen, managed by an international humanitarian non-governmental organisation. It is responsible for...

Beyond audit: Embracing QI methodology to drive improvements in lung-protective ventilation.

Mechanical ventilation supports patients with respiratory failure during critical illness. Evidence suggests that excessive tidal volumes (regarded as >8 mL/kg predicted body weight [PBW]) cause lung damage through increased lung stretch and alveolar inflammation. Lung-protective ventilation strategies have been shown to decrease morbidity and mortality, and that all patients should receive tidal volumes between 6 and 8 mls/kg PBW. Despite this, studies demonstrate that fewer than half of patients in critical care successfully receive lung-protective ventilation. The primary aim was to reduce tidal volumes delivered to all patients receiving mandatory ventilation, with a target of >85% of tidal volumes delivered to be compliant with lung-protective ventilation strategies by the end of November 2019. A multidisciplinary team of nurses and doctors, based in a UK tertiary hospital, utilized the Institute for Healthcare Improvement's (IHI) quality improvement methodology to improve compliance with lung-protective ventilation. Baseline data demonstrated that only 60.1% of tidal volumes recorded were compliant with lung-protective ventilation. Quality improvement (QI) methodology was utilized to systematically diagnose the aetiology of poor compliance and to produce and implement solutions. Real-time data collection and reporting were utilized to monitor and report improvement. Following 8 months of continuous data collection and repeated PDSA cycles, sustainable compliance with lung-protective ventilation for >85% of tidal volumes was achieved. The use of QI methodology to implement low tidal volume ventilation has shown a significant improvement in the delivery of lung-protective ventilation. Using QI methodology is central to this sustained improvement and offers a useful tool to systematically approach complex clinical problems. Lung protective ventilation is critically important in the management of ventilated patients, although compliance in intensive care is variable. Here, we describe how quality improvement methodology can lead to consistent and sustainable improvement in the delivery of lung protective ventilation.

Quality Improvement Efforts to Reduce Opioid Prescribing From a Pediatric Emergency Department.

Since the early 1990s, the United States has been fighting the epidemic of opioid addiction. Increases in the prescription of over-the-counter opioid pain medications were correlated with a notable rise in overdose deaths as early as 1999.1 These trends may have been driven in part by national efforts to improve the assessment and management of pain among patients and the “pain as a fifth vital sign” culture.2 In this issue of Pediatrics, Bryl et al3 describe their quality improvement (QI) initiative to decrease prescription of opioid medications at discharge from their urban pediatric emergency department. Evaluation of data showing that nearly half of the opioid-related deaths among patients 0 to 21 years in the San Diego area involved patients seen at their institution prompted a call to action. As the largest pediatric provider in that region, achieving a decrease in the group’s prescription of opioid medications could have a significant impact on this population.The team used rigorous QI methods to guide their initiative. These included developing a specific aim; defining outcome, process, and balancing measures; and implementing interventions by using plan-do-study-act cycles. Statistical process control charts were used to track and analyze their data. Their results were dramatic: they achieved >90% reductions in their primary outcome measures of opioid doses prescribed per week and per visit in the emergency department. Importantly, they did not see any concerning trends in their balancing measures of return visits or poor pain control assessed on follow-up phone calls.First, among their interventions, the strongest appeared to be the use of clinical decision support as a “nudge” in the form of fixed discharge dosage limits within the electronic medical record (EMR).4 First described in 2008, clinical nudges represent low-cost, highly effective strategies for changing behaviors by limiting choice, leading to decreased variation. These types of interventions are often instrumental in sustaining change long-term.Second, any effort to reduce opioid prescriptions must use a balanced approach to achieve safe prescribing while adequately treating pain. Bryl et al3 used several balancing measures, including follow-up phone calls to discharged patients, and found no evidence of undertreatment. It is notable, however, that the group only reached 17% of patients, making it difficult to assess the impact of this project’s dosage choice on pain management at this time.Third, although the overall QI methods used were robust, their QI team did not include patients and families. When developing initiatives involving direct patient care, it is important to consider inclusion of patients and families, because these stakeholders can provide pivotal information related to patient adherence and preferences.The work of Bryl et al3 should be considered in the larger context of opioid reduction efforts. With their study, they support the current literature that leftover opioid medication can be a major source of misuse, abuse, and diversion.5 It is evident that reducing overall opioid doses prescribed may be an important avenue toward addressing the opioid crisis. However, opioid prescribing for children and adolescents accounts for only a fraction of the overall opioids prescribed.6,7 This highlights the critical need for partnering with general emergency medicine colleagues and adult health care providers to ensure improved stewardship of opioid prescribing. Groenewald et al8 suggest best practices include: “1) create guidelines to guide responsible opioid prescribing and reduce leftover medications, 2) educate adolescents about risks of opioids and how to safely dispose of opioids, and 3) reduce illicit prescriptions by using state Prescription Drug Monitoring Programs (PMPs).” The study by Bryl et al3 demonstrates how use of QI methodology can bring these strategies to front line providers in the pediatric emergency department.Initiatives involving guideline development, EMR modifications, and education have broad applicability and are easily implemented, making them ideal interventions for most emergency departments. The dramatic overall opioid reduction achieved by Bryl et al3 is not surprising. In a previous study, Guarisco et al9 used similar interventions in a general emergency department setting and demonstrated a 70% reduction in prescription rates for some physicians, without negatively impacting patient satisfaction scores. This suggests that such opioid reduction outcomes could be successfully replicated in other institutions and interventions are generalizable to all age groups. Another impressive achievement with this study is the sustainability of the initiative. Although strategies such as education have been shown to wane over time, fixed function changes, such as EMR dosing limits, are neither time-bound nor provider-dependent and are easily tracked for data collection.This initiative provides a wonderful example of a project which can be undertaken within other emergency departments to decrease opioid prescribing in the pediatric population. Thoughtful QI efforts and a commitment to change can have broad implications in the care we provide to our patients.

P0528 / #493: REDUCING DRUG ERRORS IN THE PAEDIATRIC CRITICAL CARE UNIT: A QUALITY IMPROVEMENT PROJECT

Aims & Objectives: Drug errors cause considerable harm to patients. A recent spot-check on our Paediatric Critical Care Unit (PCCU) revealed a culture of under-reporting errors. By increasing the reporting of errors and implementing change following analysis of the type of errors that occurred, we aimed to reduce drug errors in the PCCU by 30% by February 2020. Methods: Using Quality Improvement (QI) methodology we created a driver diagram and process map using members of the multidisciplinary team to better understand the main areas where drug errors could occur. “Plan, Do, Study, Act” (PDSA) cycles were used to develop and improve the reporting tool, frequency and timing of use. Data collected on a weekly basis included: number of errors per active drug prescription; staffing acuity and monthly Datixes. Change ideas included: reintroduction of a prescribing zone and “Dual Prescribing” followed by PDSA cycles to evaluate them. Results: An increase in errors was initially noted, with an average of 1.1 errors per active prescription. By December 2019 this had decreased to an average of 0.28 errors per prescription. Feedback revealed that “Dual Prescribing” of all new prescriptions by the nurse in charge was too time consuming, but was tolerated by the bedside nurse for their individual patient. In times of busyness it was felt that this would be difficult. Conclusions: Reducing drug errors through the use of QI methodology is possible. Further testing and refining of the current change ideas should result in an improved system of prescribing within the PCCU.

Improving Pediatric Residents' Screening for Access to Firearms in High-Risk Patients Presenting to the Emergency Department.

Access to a firearm is a significant risk for completed suicide or homicide. We sought to increase the rate of screening for access to firearms in patients who presented to the emergency department with suicidal or homicidal ideation or suicide attempt through the use of quality improvement methodology. Patient records were eligible for inclusion if the child was under the age of 19 and presented to the emergency room of our tertiary medical center with a diagnosis of suicidal ideation, homicidal ideation, or suicide attempt. Records were manually reviewed for demographic information and documentation of screening for access to firearms. A baseline survey of the pediatric residents was completed to identify perceived barriers to screening for access to firearms. Subsequently, three "Plan, Do, Study, Act" (PDSA) cycles consisting of a noon conference, a dedicated grand rounds, and an electronic health record template were completed. During the baseline and study period, 501 patients met inclusion criteria. Forty-one of sixty-six (62.1%) residents completed a baseline survey and identified barriers to screening. There was no significant increase in screening following the first or second PDSA cycles. Following the third PDSA cycle, screening rates increased from 4% to 34%. Quality improvement methodology can be used to increase the rates of screening for access to firearms in high-risk patients. Further work is necessary to identify additional strategies to further increase screening rates.

Improving the efficiency of same-day ill calls.

56 Background: Burnout is a syndrome whose manifestations include pervasive emotional and physical exhaustion, depersonalization, a lack of motivation and an inability to complete tasks efficiently. We sought to use quality improvement (QI) methodology to approach problems contributing to burnout and workplace stress in our oncology care team. Methods: Through a broad survey of cancer center team members, we identified the coordination of same-day outpatient visits for acutely ill oncology patients as a source of excessive stress for team members across various disciplines including case managers, infusion clinic nurses, advanced practice providers, and physicians. We used the Plan-Do-Study-Act (PDSA) framework to identify a feasible, appropriate intervention to reduce the time required to coordinate visits with the specific aim of reducing the time to schedule an ill patients by 25%. We generated a cause and effect diagram to map the elements involved in the ill call scheduling process, and used a priority/payoff matrix to evaluate possible countermeasures that could streamline the process by re-designing/improving the efficiency of the workflow for scheduling ill calls. Our initial workflow involved paging individual practitioners at three locations. The process led us to the creation of a HIPPA-compliant group text to simultaneously coordinate scheduling of an ill call among/between three campuses in a more collaborative/efficient manner. We tracked time from patient call to time of scheduled appointment pre- and post-test of change (Voalte group text). We also tracked quantity of phone calls required to arrange a visit and perceived frustration with the process. Results: After one PDSA cycle, we found case manager time required to arrange a visit had decreased by 21%, number of calls required by 59% and frustration with the process by 41%. Conclusions: While we did not meet our specific aim of decreasing scheduling time by 25%, we feel use of a QI approach led to an easily implemented, yet effective modification to streamline a previously inefficient and disruptive workflow. The use of QI methodology ensured we understood the baseline process and involved all stakeholders before implementing a change and also ensured we followed data to understand the impact of our intervention on team members. Viewing sources of burnout and workplace frustration through the lens of QI may lead to more consistently high-yield interventions than traditional wellness-based, administrative approaches.

Piloting a Quality Improvement Intervention for Urinary Catheter Removal to Reduce Catheter-Associated Urinary Tract Infection in a Medical Intensive Care Unit

Background: Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent healthcare-associated infections (HAIs) globally, contributing to increased morbidity, prolonged hospital stays, and increased healthcare costs. Interventions that support prompt removal of the urinary catheter are evidence-based actions to effectively reduce CAUTI rates.1Objective: At the National Hospital of Tropical Disease (NHTD), catheter removal interventions in the intensive care unit (ICU) were implemented using quality improvement (QI) methodology to reduce CAUTI incidence and urinary catheter device utilization. Methods: Training was performed for ICU clinical staff with knowledge checks before and after the program. A bedside visual reminder of CAUTI risk and checklist to assess catheter need were implemented. Weekly compliance of provided visual reminders and checklists were measured using a simple audit tool. Device utilization ratios (DURs, ratios of device days to patient days), and CAUTI incidence rates (per 1,000 device days) were collected at baseline (July–September 2018) and quarterly thereafter until June 2019. Statistical significance was determined by an independent t test. Results: In the first quarter (October–December 2018), the CAUTI incidence rate decreased from 8.9 to 1.3 per 1,000 device days (P = .036). The ICU staff trained in CAUTI prevention, mean knowledge scores before and after training increased from 68% to 87%. The DUR decreased slightly from 0.59 to 0.55 after the first-quarter training then steadily increased in the following quarter (0.60; January–March 2019) and after the intervention (0.54; April–June 2019). CAUTI incidence rates also increased but were still lower than at baseline: 4.8 and 6.3 per 1,000 days of device use. Compliance of reminders was 51% during the first quarter, increased slightly in the second quarter 62%, then decreased to 40% during the last quarter. The nurses’ adherence to the daily checklist remained stable (>75%). Conclusions: This CAUTI prevention project was the first use of quality improvement methodology to implement change at NHTD. A trend decrease in CAUTI was observed, though a greater decrease occurred at the beginning of the intervention. Limited compliance of daily reminders is likely reflected in no statistically significant decrease in DUR. Possibly, this quality improvement project raised awareness among clinicians to improve general CAUTI prevention practices in the ICU without decreasing DUR. Given limited compliance with reminder and checklists, the intervention will be revised during the next PDSA cycle to improve adherence.1Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.Funding: NoneDisclosures: None

Successful Chest Radiograph Reduction by Using Quality Improvement Methodology for Children With Asthma

To measure the effect of implementing quality improvement (QI) methodology on the rate of chest radiograph (CXR) ordering for pediatric patients with acute asthma exacerbations.A total of 6680 pediatric patients age ≥2 years seen in the emergency department (ED) of a tertiary care children’s hospital for acute asthma were included in the study.Children ≥2 years old were retrospectively identified by chart review from May 2013 to April 2017. Included subjects had a primary International Classification of Diseases, Ninth Revision or 10th Revision billing code for asthma. An asthma clinical practice guideline (CPG) for CXR ordering in the ED was implemented in May 2014. Thus, the data from May 2013 to April 2014 were included as a 1-year baseline before intervention. Additional QI methods included removal of CXR as a default component of the electronic medical record asthma order set (July 2015), public reminder placement (January 2016), and targeted resident education (February 2016). The primary measure was CXRs ordered as a percentage of total acute asthma encounters, with a preintervention goal of <20%.A total of 1539 CXRs were ordered during 6680 patient encounters. Hospital-wide implementation of an asthma CPG was associated with a decrease in CXR use in acute asthma visits, from 29.3% to 23.0%. Implementation of targeted QI measures was associated with a further reduction in CXR use to 16.0%, which was sustained for 14 months (from February 2016 to April 2017). CXR use decreased from 21.3% to 12.5% in the subset of patients discharged from the hospital from the ED and from 53.5% to 31.1% among patients ultimately admitted to the hospital.Investigators in this study describe sustained reduction in CXR ordering in pediatric patients with acute asthma exacerbations after implementation of a CPG, later followed by QI interventions targeted at the electronic medical record system and at provider education.Old habits die hard. Previous studies have established that routine use of CXR in the evaluation of children with acute asthma exacerbations, the most frequent cause of childhood hospitalization in the United States, is of low diagnostic yield and is associated with significant risk, including unnecessary antibiotic administration. Despite evidence demonstrating low utility of CXR in this setting, implementation of “best” practice into clinical routine is challenging and can take years before change occurs. This study demonstrates how QI methodology can help break old habits, improve clinical care through patient-centered outcome measures, and most importantly, assist clinicians working in busy medical settings. It is impossible for any of us to stay current with the rapidly evolving world of medical knowledge. That is why dedicated use of QI methodology and commitment to changing culture can be so valuable.

Improving long-lasting insecticidal nets use in Kayange community of north-western Burundi: a pilot study exploring the use of quality improvement methodologies in low-resource community settings

Quality improvement (QI) approaches have demonstrated a lot of promise in improving clinical care processes, both in high-resource and low-resource settings. However, most examples of QI initiatives in healthcare in...

Reducing antipsychotic medication in ID using QI methodology

PurposeResearch highlights that antipsychotic medications are prescribed more in people with Intellectual Disability (ID) without a diagnosis of severe mental illness. Despite non-pharmacological interventions recommended as alternatives, their application can be challenging due to heterogeneity of the patient group. The purpose of this paper is to discuss application of quality improvement (QI) methodology in adapting interventions, aiming to reduce challenging behaviour of people with ID, thereby reducing use of antipsychotic medication.Design/methodology/approachTwo interventions were introduced as “tests of change”; an “Attention-Deficit Hyperactivity Disorder (ADHD) clinic” and “Positive Behaviour Support (PBS) clinic”. Process (Clinical Global Impression (CGI) and Modified Overt Aggression Scale (MOAS)) and outcome measures (total antipsychotic use) were used to assess the interventions, with each being reviewed as per QI methodology guidelines.FindingsThere was an improvement in CGI scores for both interventions. MOAS scores reduced for those attending the ADHD clinic, resulting in reductions of antipsychotic medication. MOAS scores did not reduce for the PBS clinic, so there was no reduction in medication for this group.Originality/valueBased on the introduction of pilot clinics, this paper provides a commentary on how QI interventions can be used to evaluate and adapt evidence-based interventions, in managing the needs of patients with ID. It further highlights the importance of the diagnosis of ADHD in patients with ID and challenging behaviour. Although PBS is recommended to manage challenging behaviour, this paper demonstrates the importance of continuous evaluation of behavioural interventions. There is currently no existing literature investigating use of QI methodology to reduce challenging behaviour in ID populations, emphasising scope for future research and service evaluation.

A Quality Improvement Initiative to Reduce Safety Events Among Adolescents Hospitalized After a Suicide Attempt.

Self-harm among adolescents is a common problem, resulting in large numbers of patients admitted for medical stabilization after a suicide attempt. Because of limited mental health resources, these high-risk patients remain in inpatient settings once medically stabilized until psychiatric placement can be arranged. During this time, patients are at risk for safety events, including self-harm and elopement. Using quality improvement (QI) methodology, we aimed to reduce the frequency of significant safety events (SSEs) in this population by targeting modifiable risk factors and standardizing care. This was a QI study conducted at a medium-sized academic center. Key interventions included the development of the Pediatric Behavioral Health Safety Protocol, standardization of the patient safety search, and implementation of a daily Safety Huddle. Process measures were selected as metrics of use and adherence to the newly developed protocol. The rate of SSEs per 100 patient days was the primary outcome measure. There were 224 patients included in our study: 53 in the preimplementation and 171 in the postimplementation groups. Use of the Pediatric Behavioral Health Safety Protocol increased to 91.8% after implementation. The rate of SSEs per 100 patient days decreased from an average of 2.7 events per 100 patient days in the preimplementation period to 0.17 events per 100 patient days in the postimplementation period. The use of QI methodology to improve safety for adolescents admitted after a suicide attempt led to a substantial and sustainable reduction in the rate of SSEs at our institution.

Increasing Trichomonas vaginalis testing for high-risk adolescents a pediatric emergency department.

Background:Trichomonas is a common sexually transmitted infection (STI) among adolescents, causing vaginal discharge, pelvic pain, and dysuria. Affected individuals have increased susceptibility to other STIs and may have pregnancy complications. A quality improvement project was developed to increase trichomonas testing among high-risk adolescent patients from 40% in July 2014 to 100% by December 31, 2014, and sustain over 6 months.Methods:An interdisciplinary team (providers and support staff) was assembled to address this objective. We collected 6 months of baseline data. Deploying the Institute for Healthcare Improvement Model for Improvement, we formulated an aim statement and identified key drivers. We used cause analysis to identify interventions for each problem area. Multiple Plan-Do-Study-Act cycles were undertaken, and results were monitored using control charts. Interventions included increasing awareness and education for clinical staff; changing computer order entry for the test; using order sets for STI; and adding a Licensed Professional Initiated Protocol to nurse ordering practice. These interventions were all done in conjunction with feedback to providers for individual missed cases.Results:Over 18 months, the trichomonas testing rate rose with each intervention: from 25% (January 2014) to 98% (December 2014), which we have sustained through June 2015.Implications and Contributions:This article demonstrates the successful use of quality improvement methodology to increase rates of Trichomonas vaginalis testing among at-risk adolescent patients. Increased testing results in increased detection and improved treatment and sexual health for our patients.Conclusion:Improving the trichomonas testing process in the pediatric emergency department results in higher screening rates among high-risk adolescent patients.