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Improving Time to Diagnosis and Management of Pediatric Patients with Acute Neurologic Dysfunction
Insights
A new clinical pathway significantly reduced diagnostic times for pediatric patients with neurologic dysfunction in the emergency department. This pathway utilizes fast magnetic resonance imaging (MRI) for quicker diagnosis and improved patient care.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Radiology
- Quality Improvement Science
Background:
- Pediatric patients presenting with new neurologic dysfunction to the emergency department require rapid evaluation.
- While stroke alerts are common, most pediatric neurologic emergencies are not strokes and require advanced imaging like magnetic resonance imaging (MRI).
- Existing diagnostic timelines often delay appropriate evaluation and treatment for these critical pediatric cases.
Purpose of the Study:
- To implement a "Neuro Deterioration" clinical pathway in a pediatric emergency department (PED).
- To significantly reduce the time from patient arrival to the completion of radiologic reports for pediatric patients with new-onset neurologic dysfunction.
- To improve the diagnostic efficiency for a broad range of pediatric neurologic emergencies, not limited to stroke.
Main Methods:
- Utilized quality improvement methodology to develop and implement the Neuro Deterioration clinical pathway.
- Focused interventions on enhancing patient identification, streamlining patient flow, and integrating electronic decision support tools.
- Employed statistical process control charting to monitor and assess the impact of implemented interventions.
Main Results:
- Achieved a 32.2% reduction in the time from PED arrival to radiologic report completion, decreasing average time from 211 to 143 minutes.
- Reduced the average time from PED arrival to image completion by 48 minutes (from 179 to 131 minutes).
- Increased the percentage of patients managed via the pathway, with 87.5% receiving fast MRI for initial imaging and a high rate of non-stroke diagnoses.
Conclusions:
- Successfully developed and implemented a sustainable Neuro Deterioration clinical pathway.
- Demonstrated significant improvements in reducing diagnostic times for pediatric patients with neurologic findings in the PED.
- The pathway effectively facilitates timely diagnosis for a wide spectrum of pediatric neurologic emergencies.
Background:
Children presenting to the pediatric emergency department (PED) with neurologic dysfunction require prompt evaluation. Many PEDs successfully implement stroke alerts. However, most pediatric patients presenting with neurologic dysfunction have a non-stroke diagnosis better evaluated using magnetic resonance imaging (MRI). Therefore, we created a Neuro Deterioration clinical pathway using fast MRI to reduce time from PED arrival to completion of radiologic report by 25% in all PED patients presenting with new neurologic dysfunction.
Methods:
After creating an algorithm and allocating resources, the team used quality improvement methodology to implement a Neuro Deterioration clinical pathway. Interventions focused on patient identification, patient flow, and electronic decision support. Statistical process control charting assessed interventions. The primary outcome measure was time from PED arrival to completion of radiologic report. Additional measures included time from arrival to image finish and percentage of patients on pathway.
Results:
From 2018 to 2021, time from PED arrival to completion of radiologic report reduced by 32.2%. The average time decrease from a baseline of 211 (n = 287, January 2018-August 2019) to 143 minutes (n = 162, October 2020-December 2021), as noted by a centerline shift on the statistical process control chart. Average time from PED arrival to image finish decreased from 179 to 131 minutes. Percentage of patients on pathway increased. The average age of patients on pathway was 11.5 years, 63.8% were admitted, and 87.5% had a fast MRI for initial imaging. Of the 30.4% of patients with abnormal findings on initial imaging, 85.8% had non-stroke etiologies.
Conclusion:
The authors created a sustainable Neuro Deterioration clinical pathway to improve time to diagnosis of all pediatric patients with neurologic findings in the PED.
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