Let Us Use LET: A Quality Improvement Initiative.

Area of Science:

• Pediatric Emergency Medicine
• Pain Management
• Quality Improvement Initiatives

Background:

• Effective pain management in children improves recovery and satisfaction.
• Deficiencies exist in pediatric pain management practices.
• LET gel (lidocaine 4%, epinephrine 0.1%, tetracaine 0.5%) is a standard topical anesthetic for laceration repair.

Purpose of the Study:

• To assess if educational interventions within a quality improvement framework enhance early topical anesthetic use in a pediatric emergency department.
• To evaluate the impact of educational initiatives on the administration rates and timing of LET gel for pediatric facial lacerations.

Main Methods:

• Implementation of an educational session and a poster at the triage booth.
• Retrospective chart review of pediatric patients with facial and scalp lacerations before, one month after, and one year after the initiative.
• Assessment of LET gel usage rates and time to administration.

Main Results:

• Pre-initiative LET gel use was 57.4% with a mean application time of 58.3 minutes.
• One month post-initiative, LET gel application increased by 20.1%, and time to application decreased by 35.9 minutes (P < 0.05).
• Improvements were sustained one year later, with 82.4% receiving LET gel and a mean application time of 27.8 minutes.

Conclusions:

• Simple educational initiatives are effective in improving topical anesthetic use in pediatric emergency settings.
• Quality improvement initiatives incorporating educational tools can significantly enhance LET gel application rates and reduce administration time for pediatric facial lacerations.
• The observed improvements in LET gel usage and administration time were sustainable over one year.