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91 to 11.10 days in Q1 2015. In a subgroup analysis of the 657 lines placed in surgical patients, there was a centerline shift in mean CVC duration from 6.48 to 8.86 days in Q4 2013. Conclusions Our study demonstrated an unexpected increase in mean CVC duration after the implementation of a safety checklist designed to decrease nonessential CVC days. Additional studies are needed to identify the ideal method to detect and remove nonessential CVCs and reduce the risk of preventable harm. Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.The clinical management of well-appearing febrile infants 7-60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG). Methods The Model for Improvement was used to implement a CPG for the management of well-appearing febrile infants, with collaboration between pediatric emergency medicine and pediatric hospital medicine physicians. Interventions included physician education, process audit/feedback, and development of an electronic orderset. We used statistical process control charts to assess the primary aims of appropriate risk stratification and length of stay. Results Over a 34-month period, 168 unique encounters (baseline n = 65, intervention n = 103) were included. There was strong adherence for appropriate risk stratification in both periods the proportion of low-risk patients admitted inappropriately decreased from 14.8% to 10.8%. Among admitted high-risk patients, the mean length of stay decreased from 49.4 to 38.2 hours, sustained for 18 months. Conclusion CPG implementation using quality improvement methodology can increase the delivery of evidence-based care for febrile infants, leading to a reduction in length of stay for high-risk infants. Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.Quality patient handoff is vital in patient care and attainable with structured handoff systems, such as the I-PASS mnemonic. This paper describes a continuous quality improvement study occurring after the implementation of the I-PASS handoff bundle. Our objectives were to (1) determine compliance with the inclusion of I-PASS elements during handoff and (2) determine whether the addition of CORES, an electronic tool that generates a patient list designed for use with I-PASS, would improve compliance and sustainability. Methods We developed an aim statement 90% of handoffs would include all 6 I-PASS elements within 6 months of the addition of CORES. Two plan-do-study-act (PDSA) cycles were conducted. In PDSA 1, we implemented CORES. In PDSA 2, we reeducated residents on I-PASS elements and the importance of a quality handoff. We used a checklist to evaluate the inclusion of I-PASS elements. Following PDSA 2, we administered a survey regarding CORES to involved residents. Results During PDSA 1, illness severity, diagnosis, patient summary, contingency planning, action list, and receiver synthesis were present in 13%, 62%, 52%, 87%, 42%, and 25% of handoffs, respectively. Overall compliance was 47%. During PDSA 2, illness severity remained stable at 13% whereas the remainder increased to 84%, 82%, 93%, 91%, and 37%. Overall compliance increased to 67%. Following PDSA 2, 100% of survey respondents reported improved handoff with CORES. Conclusions In this study, we show that neither implementation of CORES nor resident reeducation resulted in the return to high postintervention compliance observed after implementation of the I-PASS handoff bundle. Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.Recommended time to start administration of first dose antibiotics for sepsis patients is 60 minutes from time 0. Institution-specific data revealed that only one-quarter of severe sepsis patients were meeting this goal when measured from the time of provider order entry. Reliance on a pneumatic tube system for first-dose antibiotic delivery was deemed largely responsible for this finding. This project aimed to increase the percentage of pediatric intensive care unit patients with severe sepsis receiving first dose antibiotics within 60 minutes of provider order entry to ≥50%. Methods Baseline data were collected from May to June 2018 and resulted in the development of a new "antibiotic champion" process, which we piloted for 1 week in early August 2018. The primary outcome measure was the cumulative percentage of patients meeting the 60-minute goal as measured from provider order entry to start of antibiotic administration. A key secondary endpoint was the median time in minutes from provider order entry to antibiotic administration. Results We included 14 patients in baseline data analysis and 16 patients in the pilot. The overall percentage of patients receiving antibiotics within 60 minutes of order entry increased from 29% to 75% (P-value 0.026). The median time from provider order entry to antibiotic administration decreased by 36.5 minutes [baseline 84.5 (range 58.8-117) versus pilot 48 (range 32-65), P-value 0.0017]. Conclusion The antibiotic champion process significantly increased the total percentage of severe sepsis patients meeting the 60-minute goal and decreased the median time to first-dose antibiotic administration for pediatric intensive care unit patients. Copyright © 2020 the Author(s). click here Published by Wolters Kluwer Health, Inc.HIV infection rates are increasing among adolescents. Despite guidelines recommending annual HIV screening among sexually active adolescents, 3.6% of adolescents tested for other sexually transmitted infections (STI) in a pediatric emergency department (PED) were screened for HIV. The aim was to increase HIV screening to 90%. Methods Interventions were designed to address 4 key drivers thought to be critical in reliably offering HIV testing. The primary outcome measure was the proportion of adolescents offered HIV testing among those being tested for common STIs. Statistical process control charts were used to measure performance over time and differentiate common versus special cause variation. Results We instituted point of care (POC) HIV testing in the PED in January 2012. The proportion of STI tested patients offered HIV testing was increased to >87% and sustained this performance. Implementation of a clinical decision support tool had the highest impact. The majority offered testing agreed, and the most common reason for refusal was a recent negative test.
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