Practice-Change Pathway to Reduce Procedural Distress During Intussusception Reduction-A Quality Improvement...

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Procedural Sedation and Analgesia

Background:

• Intussusception reduction often causes patient distress, necessitating effective pain and anxiety management.
• Despite evidence supporting their safety, analgesic and anxiolytic use during intussusception reduction remains inconsistent.
• A quality improvement initiative was launched to standardize medication provision for this procedure.

Purpose of the Study:

• To implement and assess a standardized clinical pathway for providing intranasal fentanyl and midazolam during pneumatic reduction of intussusception.
• To improve the rate of analgesic and anxiolytic medication administration to eligible pediatric patients undergoing the procedure.

Main Methods:

• A multidisciplinary team developed a standardized pathway using Plan-Do-Study-Act cycles.
• Interventions included staff education, team engagement, and process optimization.
• Key outcome measures focused on pathway provision, pain/sedation scores, and adverse events.

Main Results:

• Pathway provision for analgesia and anxiolysis increased from 0% to 100% within one year.
• Successful pneumatic reductions were achieved in 82% of planned cases.
• No serious adverse events or intestinal perforations were documented, with 100% pathway compliance.

Conclusions:

• This quality improvement initiative effectively increased the provision of analgesia and anxiolysis for pediatric intussusception reduction.
• The structured approach enhanced procedural pain management without compromising patient safety.
• The project offers a scalable model for improving pediatric procedural care in emergency settings.