Development of Quality Measures for Pediatric Agitation Management in the Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Mental Health Services
• Healthcare Quality Improvement

Background:

• Pediatric mental health emergency department (ED) visits involving restraints for agitation are increasing.
• Quality measures are crucial for assessing and enhancing healthcare delivery.
• There is a need for standardized approaches to manage agitation in pediatric ED settings.

Purpose of the Study:

• To develop comprehensive quality measures for pediatric ED agitation management.
• To incorporate multidisciplinary perspectives into the measure development process.

Main Methods:

• A modified Delphi method was employed with a multidisciplinary panel.
• Panelists (physicians, nurses, social workers, security, child life specialists, analysts, parents) ranked measures by importance and feasibility over two survey rounds and a teleconference.
• Consensus was defined as >75% ranking importance ≥7 and a median feasibility score ≥4.

Main Results:

• Consensus was reached on 20 quality measures for pediatric ED agitation management.
• Key measures prioritized included those related to adverse medication events, use of restraints, staff/patient injuries, reescalation protocols, standardized care algorithms, staff training in deescalation, medication administration timeliness, and room safety.

Conclusions:

• Twenty multidisciplinary quality measures for pediatric ED agitation management have been developed.
• These measures, upon operationalization and field testing, have the potential to significantly improve the quality of care for agitated pediatric patients in emergency departments.