The Effect of Pediatric Early Warning Score Use on Emergency Response Calls After Admission From the Pediatric Emergency Department.

OBJECTIVES: Pediatric Early Warning Scores (PEWS) are an easy-to-use diagnostic tool for patient evaluation. The goal of this study was to determine if using PEWS in our pediatric emergency department (PED) at the time of admission to the hospital was associated with a decrease in the number of emergency response calls within 6 hours of admission. METHODS: A retrospective chart review of 6 months before (May 2013-October 2013) and after (December 2013-May 2014) initiation of PEWS upon inpatient admission from our urban, tertiary care PED was conducted to determine the number of patients who had emergency response calls within 6 hours of admission. RESULTS: The percentage of patients admitted from the PED who required an emergency response call within 6 hours of admission dropped from 1.77% in the 6 months before assigning PEWS to 0.79% in the 6 months after, a 55% reduction (P = 0.0070). CONCLUSIONS: Assigning PEWS to patients being admitted to our hospital from the PED was associated with a reduced number of emergency response calls in the period immediately after admission.

A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children's Hospital.

BACKGROUND AND OBJECTIVE: Blood culture contamination is a safety and quality concern in children's hospitals; it leads to increased unnecessary testing, admissions, antibiotic exposure, and cost. The standard benchmark for blood culture contamination is 3%. Our aim with the quality improvement project was to reduce the contamination rate at our children's hospital from a mean of 2.85% to <1.5% in 2 years. METHODS: After initial unit-specific efforts, we formed a multidisciplinary team, created a process map and a cause-and-effect analysis, sent out surveys to nurses, and created observation sheets used to identify problem areas and record the most common deviations during the collection process. We also standardized the blood culture collection protocol and reemphasized nurse education in person and with online modules. During our project, we noted that nurses were collecting 1 to 3 mL of blood on all children regardless of weight. We developed optimal weight-based blood volumes and, after educating ordering providers, we updated our electronic medical record to reflect appropriate volumes in the order. RESULTS: Despite a steady increase in the number of blood cultures collected at our children's hospital, we were able to decrease the average contamination rate from 2.85% to 1.54%, saving the hospital an estimated average of $49 998 per month. CONCLUSIONS: By standardizing blood culture collection methods, optimizing blood volume, creating checklists, and reinforcing nurse education, we were able to develop a best practice for pediatric blood culture collection and reduce blood culture contamination to a sustainable low rate at our children's hospital.