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Pediatric Emergency Department Burn Discharge and Clinic Readiness: A Quality Improvement Project
Rachel Hatcliffe1, Anne Ciriello2, Elizabeth Murphy Waibel2
1From the Pediatric Emergency Department, Children's National Hospital, Washington, D.C.
Insights
Improving pediatric burn care adherence is crucial. This project enhanced discharge instructions and pain management, significantly increasing correct instruction packet distribution and oxycodone prescriptions for outpatient follow-up.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Wound Care Management
Background:
- The shift to outpatient care for pediatric burn injuries increases caregiver responsibility for wound care and follow-up.
- Nonadherence to burn care and appointments can negatively impact patient outcomes.
- Effective parental education and pain management during dressing changes are key to adherence.
Purpose of the Study:
- To improve the distribution of correct discharge instruction packets for pediatric burn patients.
- To increase the rate of oxycodone prescriptions for premedication before initial clinic appointments for qualifying patients.
Main Methods:
- A multidisciplinary team used a fishbone diagram to identify barriers and a key driver diagram to design interventions.
- Interventions included updated custom instructions, discharge pamphlets, EMR changes, and enhanced e-prescribing.
- Data were tracked monthly using statistical process control charts.
Main Results:
- The correct discharge packet distribution increased from 46% to 78%.
- Oxycodone prescriptions for premedication increased from 70% to 93% for qualifying patients.
- Interventions led to sustained improvements in both areas.
Conclusions:
- Targeted interventions successfully improved the use of custom burn discharge instructions and oxycodone prescriptions.
- Further research should investigate the impact of these interventions on appointment scheduling and patient pain scores.
Introduction:
The shift to outpatient care for pediatric burn injuries has placed a greater responsibility on caregivers for wound care and follow-up planning. Nonadherence to burn care and follow-up appointments can lead to negative emotional and physical health outcomes. Both parental education and pain control with dressing changes are important factors for adherence to outpatient care. This single-center quality improvement project aimed to improve pediatric burn patients discharged from the emergency department with the correct instruction packet and the percentage of qualifying patients prescribed oxycodone for premedication for their initial clinic appointment.
Methods:
A multidisciplinary team retrospectively examined barriers using a fishbone diagram, developed a key driver diagram, and designed interventions, including updated custom instructions, printed discharge pamphlets, electronic medical record changes, enhanced e-prescribing access, linked International Classification of Diseases, Tenth Revision codes, targeted provider feedback, and education sessions. We tracked monthly data using statistical process control charts.
Results:
At baseline, 46% of patients received the correct discharge packet; following interventions, we observed a centerline shift to 78% with sustained improvement. Seventy percent of qualifying patients received an oxycodone prescription for premedication before clinic follow-up at baseline, and we saw a sustained baseline shift to 93% after interventions.
Conclusions:
Following multiple targeted interventions, there was a sustained improvement in the use of a custom burn discharge instruction packet and oxycodone prescriptions. Future research should examine the impact of discharge instructions and oxycodone prescriptions on the timeliness of outpatient appointment scheduling and pain scores.
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