Learning From a National Quality Improvement Collaborative for Brief Resolved Unexplained Events.

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Clinical Practice Guidelines

Background:

• The American Academy of Pediatrics published clinical practice guidelines (CPG) for Brief Resolved Unexplained Events (BRUE) in 2016.
• A quality improvement (QI) collaborative was initiated across 15 hospitals to enhance adherence to these BRUE guidelines.

Purpose of the Study:

• To improve adherence to the BRUE CPG, focusing on testing, hospitalization of lower-risk infants, diagnostic criteria, and risk classification.
• To evaluate the impact of a multicenter QI collaborative on BRUE care processes and outcomes.

Main Methods:

• A QI collaborative involving 15 hospitals implemented interventions including CPG education, updated documentation, clinical pathways, and EHR integration.
• Medical record review analyzed care for 1756 infants meeting BRUE criteria across three periods: pre-CPG, post-CPG, and the collaborative period.
• Collaborative learning sessions were used to identify and address barriers to improvement.

Main Results:

• Following CPG publication, testing adherence increased from 56% to 64%, and hospitalization of lower-risk infants decreased from 49% to 27%.
• During the collaborative, correct risk classification improved significantly (26% to 49% in ED, 15% to 33% inpatient).
• Documentation of BRUE risk factors improved from 84% to 91% in the ED setting.

Conclusions:

• The national BRUE QI collaborative successfully enhanced hospital processes and outcomes related to BRUE care.
• While testing and hospitalization rates did not surpass initial post-CPG gains, the collaborative improved risk classification and definition adherence.
• Future improvements may involve integrating caregiver perspectives and shared decision-making tools.