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Digesting the problem: standardising care for children who present to ED after ingesting foreign bodies
Wilhelmina Fouche1, Sinead McDonnell1, Clare Roche2
1Department of Emergency Medicine, University Hospital Galway, Galway, Ireland.
Insights
A new guideline improved pediatric foreign body ingestion management in the emergency department (ED), increasing correct treatment rates from 55% to over 87%. This quality improvement initiative also reduced unnecessary imaging and specialist referrals.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Clinical Guideline Development
Background:
- Foreign body ingestion is a frequent cause of pediatric emergency department visits.
- Initial management adherence to best practices was suboptimal (55%) at the institution.
- No specific local guideline existed for managing these cases.
Purpose of the Study:
- To implement a locally developed guideline and educational intervention.
- To enhance adherence to best practices for pediatric foreign body ingestion management.
- To improve correct management rates from a baseline of 55% to over 80%.
Main Methods:
- A 5-month quality improvement project in a tertiary emergency department.
- Utilized three plan-do-study-act (PDSA) cycles for iterative improvement.
- Interventions included guideline creation, dissemination, and case-based education.
Main Results:
- Correct management increased significantly, from 55% at baseline to 87%-100% post-intervention.
- Unnecessary imaging decreased from 16% to 12%; inappropriate referrals dropped from 3% to 0%.
- Avoidable return visits decreased from 4% to 0% without reported harm.
Conclusions:
- A locally developed guideline effectively improved adherence to best practices for pediatric foreign body ingestion.
- The intervention demonstrated positive impacts on process measures and patient safety.
- Sustained improvement is anticipated through integration into training and hospital systems.
Background:
Foreign body ingestion is a common reason for paediatric emergency department (ED) attendance. At baseline in our institution, only 55% of children were managed in accordance with international best practice. No local guideline was in place.
Aim:
To implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.
Methods:
We conducted a quality improvement project in a single tertiary ED over 5 months, using three plan-do-study-act (PDSA) cycles. Interventions included guideline development, dissemination at NCHD induction and departmental teaching and case-based discussions. The SMART aim was to improve correct management from 55% to >80% within 5 months. The primary outcome measure was the proportion of cases managed correctly according to the guideline. Process measures were unnecessary imaging and inappropriate specialist referrals; return visits were tracked as a balancing measure. Data were analysed descriptively and displayed using a p-chart. Educational impact was explored with case vignettes.
Results:
27 consecutive patients were included in the intervention period. Correct management increased from 55% at baseline to 87%-100% across PDSA cycles, exceeding the SMART aim. Process measures improved: unnecessary imaging decreased from 16% to 12% and inappropriate referrals from 3% to 0%. Avoidable return visits fell from 4% to 0%, without evidence of harm. Case vignette scores improved modestly (54%-63%), with variation across individual cases.
Conclusion:
Introduction of a locally developed guideline significantly improved adherence to best practice in paediatric foreign body ingestion. Improvements extended to process and balancing measures, demonstrating a true test of change. Embedding the guideline in induction, teaching and the hospital intranet is expected to support sustainability.
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