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Improving croup management at a pediatric emergency department.
- Source :
-
Postgraduate medicine [Postgrad Med] 2024 May; Vol. 136 (4), pp. 438-445. Date of Electronic Publication: 2024 May 31. - Publication Year :
- 2024
-
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.<br />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.<br />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).<br />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.
- Subjects :
- Humans
Female
Male
Infant
Child, Preschool
Anti-Bacterial Agents therapeutic use
Anti-Bacterial Agents administration & dosage
Child
Length of Stay statistics & numerical data
Bronchodilator Agents therapeutic use
Bronchodilator Agents administration & dosage
Nebulizers and Vaporizers
Croup drug therapy
Croup diagnosis
Croup therapy
Emergency Service, Hospital
Dexamethasone administration & dosage
Dexamethasone therapeutic use
Quality Improvement
Epinephrine administration & dosage
Epinephrine therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1941-9260
- Volume :
- 136
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Postgraduate medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38804969
- Full Text :
- https://doi.org/10.1080/00325481.2024.2360889