Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study.

BACKGROUND: Motor vehicle collisions remain a leading cause of death and injury in children in the United States. Our Level I trauma center found that 53% of children ages 1-19 years are improperly restrained or unrestrained. Our center employs a Pediatric Injury Prevention Coalition with nationally certified child passenger safety technicians who are active in the community yet remain underutilized in the clinical setting. OBJECTIVE: The purpose of the quality improvement project was to standardize child passenger safety screening in the emergency department to increase referrals to a Pediatric Injury Prevention Coalition. METHODS: This quality improvement project utilized a pre-/postdesign of data collected before and after implementing the child passenger safety bundle. Using the Plan-Do-Study-Act model, organizational change processes were identified, and quality improvement interventions implemented from March to May 2022. RESULTS: The total number of families referred was 199, representing 230 children, which was 3.8% of the eligible population. A significant relationship was found between child passenger safety screening and referral to the Pediatric Injury Prevention Coalition in 2019 and 2021, χ2 (1, n = 230) = 239.98, p < .001, and χ2 (1, n = 230) = 240.78, p < .001, respectively. Forty-one percent of the referred families established contact with the Pediatric Injury Prevention Coalition. CONCLUSION: Standardizing child passenger safety screening in the emergency department increased referrals to a Pediatric Injury Prevention Coalition and resulted in improved child safety seat distribution and child passenger safety education.

Discharge optimization tool to decrease length of stay and improve satisfaction related to advanced practice provider communication.

BACKGROUND: Prolonged length of stay (LOS) due to delayed hospital discharge is associated with increased patient morbidity and mortality and other poor outcomes. The length of stay (LOS) in patients undergoing elective, isolated coronary artery bypass grafting (CABG) at an urban, level 1 trauma center is 8.73 days, compared to the 7.0-day benchmark reported by the Society of Thoracic Surgeons (STS). Improving and reducing length of stay (LOS) can improve clinical, financial, and operational outcomes and decrease the costs of care for patients and the healthcare system. OBJECTIVE: The purpose of this quality improvement project was to implement an evidence-based discharge optimization tool (DOT) within the Electronic Health Record to reduce LOS in patients undergoing isolated CABG and enhance communication satisfaction in cardiothoracic surgery advanced practice providers (APP). METHODS: We used a DOT to communicate anticipated time to discharge in CABG patients to the multidisciplinary team. Outcomes included postoperative LOS and APP communication satisfaction. Data was obtained via chart review and statistically analyzed using a one sample T-test. RESULTS: 177 patients (mean age 64 years, 72% male, 66% Caucasian) were studied. The mean postoperative LOS decreased by 16% from 8.73 days to 7.31 days (p = 0.007; Standard deviation of 3.20). Cardiothoracic surgery APP communication satisfaction improved by 33%. CONCLUSIONS: Utilization of a discharge optimization tool to communicate anticipated time to discharge can significantly decrease LOS and improve APP communication satisfaction.

Giant Tricuspid Valve Fibroelastoma Incidentally Diagnosed During Routine Stress Testing.

Papillary fibroelastomas (PFEs) are the most common valvular tumor, typically occurring on left-sided valves. We describe the evaluation and treatment of a giant tricuspid PFE in a healthy 43-year-old police officer who was referred for evaluation of frequent premature ventricular contractions during job-related treadmill stress testing. (Level of Difficulty: Beginner.).

Atrial fibrillation clinical decision aid for emergency medicine providers: An initiative to improve quality healthcare outcomes in adults with new-onset atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) affects 6 million Americans with an annual cost of $6 billion and a 30-day readmission rate of 15%. METHODS: We conducted a quality improvement project using pretest-posttest analysis to determine the effects of an AF clinical decision aid for Emergency Medicine providers on quality measures for patients with new-onset AF at a tertiary care facility. Outcomes included readmission rates, documentation of thromboembolic risk (CHA2DS2-VASc), bleeding risk (HAS-BLED), incidence of anticoagulation (AC) patient education, and prescription of AC. Data was obtained via chart review. Standard statistical techniques were used. RESULTS: 225 patients (mean age 67.5 years, 66% male, 76% Caucasian) were studied. The 30-day readmission rate for symptomatic AF decreased from 17% to 1.3% (p = 0.01). There was no difference in provider documentation, incidence of AC patient education, or prescription of AC following implementation. CONCLUSIONS: Utilization of a clinical decision aid significantly reduces 30-day readmission for symptomatic AF.