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Let Us Use LET: A Quality Improvement Initiative
Joshua M Sherman1, Patrick Sheppard, Eric Hoppa
1From the *Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA; †Cohen Children's Medical Center of New York, NSLIJ Health System, New Hyde Park, NY; and ‡Connecticut Children's Medical Center, Hartford, CT.
Insights
Educational initiatives significantly increased the early use of LET gel (lidocaine, epinephrine, tetracaine) for pediatric facial lacerations. This quality improvement effort also reduced application time, demonstrating sustainable benefits in pain management.
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.
Background:
Well-managed pain is associated with faster recovery, fewer complications, and decreased use of resources. In children, pain relief is also associated with higher patient and parent satisfaction. Studies have shown that there are deficiencies in pediatric pain management. LET gel (lidocaine 4%, epinephrine 0.1%, and tetracaine 0.5%) is a topical anesthetic that is routinely used before laceration repair.
Objective:
The aim of this study was to determine if educational initiatives as part of a quality improvement initiative lead to increased rates of early topical anesthetic usage in a large urban pediatric emergency department.
Methods:
The initiative consisted of an educational session and a triage booth poster. We then reviewed the charts of patients with facial and scalp lacerations for the month before the initiative, the month after the initiative, and 1 year after the initiative. We assessed if LET gel usage and time to administration improved and were sustainable.
Results:
We reviewed 138 charts. Before the initiative, only 57.4% received LET gel before facial laceration repair with a mean time to application of 58.3 minutes. One month after the initiative, there was an increase in LET gel application by 20.1% with a reduction in time to application by 35.9 minutes (P < 0.05). In addition, these improvements were significantly sustainable. One year after the interventions, 82.4% received LET before facial laceration repair, and the time to LET application was 27.8 minutes.
Conclusions:
Simple educational initiatives can improve the use of topical anesthetics. By using educational tools as part of a quality improvement initiative, we were able to significantly improve the rates of LET gel application for facial lacerations in children and decrease the time to administration.
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