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Improving croup management at a pediatric emergency department.
Akcan Yildiz, Leman; Akca, Halise; Kurt, Funda; Hanalioglu, Damla; Cetin, Meltem; Senel, Saliha; Karacan, Can Demir.
Afiliação
  • Akcan Yildiz L; Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Türkiye.
  • Akca H; Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Türkiye.
  • Kurt F; Pediatric Emergency Department, Ankara Yildirim Beyazit University, Ankara, Türkiye.
  • Hanalioglu D; Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Türkiye.
  • Cetin M; Pediatric Emergency Department, University of Health Sciences, Ankara, Türkiye.
  • Senel S; Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Türkiye.
  • Karacan CD; Pediatric Emergency Clinic, Ankara Bilkent City Hospital, Ankara, Türkiye.
Postgrad Med ; 136(4): 438-445, 2024 May.
Article em En | MEDLINE | ID: mdl-38804969
ABSTRACT

OBJECTIVES:

Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup.

METHODS:

In this quality improvement (QI) initiative, all pediatric residents starting their rotation in the PED attended an informative presentation about croup and were provided reminders throughout their rotation. The primary outcome of this QI initiative was to reduce nebulized epinephrine (NE) use among children with mild croup by 50% over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months. Other outcomes included the administration of dexamethasone to all children with croup, reduction of antibiotics, laboratory tests, and revisits, and shortening the duration between physical examination to dexamethasone and NE treatments, and the length of stay (LOS) at the PED.

RESULTS:

NE administration to patients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from 37.4% to 17.1% (p < 0.001). There was a significant increase in dexamethasone administration, and significant decreases in laboratory blood tests, expanded viral PCR panel tests, and antibiotic prescription among all croup cases (p < 0.001). Revisit rates were not significantly different (p > 0.05). Time to dexamethasone and LOS shortened significantly (p < 0.001).

CONCLUSION:

With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dexametasona / Epinefrina / Crupe / Serviço Hospitalar de Emergência / Melhoria de Qualidade Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Dexametasona / Epinefrina / Crupe / Serviço Hospitalar de Emergência / Melhoria de Qualidade Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2024 Tipo de documento: Article