Improving croup management at a pediatric emergency department

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Respiratory Illness Management

Background:

• Over-testing and over-treatment are prevalent in pediatric emergency departments (PEDs) for children diagnosed with croup.
• Current practices often lead to unnecessary interventions, increasing healthcare costs and potential patient harm.

Purpose of the Study:

• To enhance the quality of care for pediatric patients presenting with croup.
• To significantly reduce the utilization of nebulized epinephrine (NE) and X-rays in children with mild croup.

Main Methods:

• A quality improvement (QI) initiative was implemented, including educational presentations for pediatric residents on croup management.
• Key performance indicators focused on reducing NE use and X-ray frequency by 50% over seven months.

Main Results:

• Nebulized epinephrine (NE) administration for mild croup decreased from 80.2% to 36.3%.
• The proportion of children undergoing X-rays dropped from 37.4% to 17.1%.
• Significant increases in dexamethasone use and reductions in antibiotics, laboratory tests, and length of stay were observed.

Conclusions:

• The QI intervention successfully decreased NE, antibiotic, and X-ray rates without increasing patient revisits.
• Despite improvements, high rates of unnecessary NE, antibiotic, and X-ray utilization persist, indicating a need for continued optimization.