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American Academy of Pediatrics
Quality Reports

Improving Care and Outcomes for Pediatric Musculoskeletal Infections

Gabrielle Z. Hester, Amanda J. Nickel, David Watson, Gloria Swanson, Jennifer C. Laine and Kelly R. Bergmann
Pediatrics February 2021, 147 (2) e20200118; DOI: https://doi.org/10.1542/peds.2020-0118
Gabrielle Z. Hester
aDepartments of Quality,
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Amanda J. Nickel
bResearch Institute, Children’s Minnesota, Minneapolis, Minnesota; and
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David Watson
bResearch Institute, Children’s Minnesota, Minneapolis, Minnesota; and
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Gloria Swanson
cHospital Medicine,
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Jennifer C. Laine
dOrthopedic Surgery, and
eGillette Children’s Specialty Healthcare, St Paul, Minnesota
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Kelly R. Bergmann
fEmergency Medicine and
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Abstract

BACKGROUND: Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration.

METHODS: We implemented 4 prospective QI interventions at our tertiary children’s hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015–October 17, 2016) and implementation (October 18, 2016–April 2019).

RESULTS: In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%–11%; 95% confidence interval 70–92) and 33% relative reduction in sedations per patient (centerline shift 1.8–1.2; 95% confidence interval 21–46). Empirical vancomycin use did not change (centerline 20%).

CONCLUSIONS: Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration.

  • Accepted July 6, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 2
1 Feb 2021
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Improving Care and Outcomes for Pediatric Musculoskeletal Infections
Gabrielle Z. Hester, Amanda J. Nickel, David Watson, Gloria Swanson, Jennifer C. Laine, Kelly R. Bergmann
Pediatrics Feb 2021, 147 (2) e20200118; DOI: 10.1542/peds.2020-0118

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Improving Care and Outcomes for Pediatric Musculoskeletal Infections
Gabrielle Z. Hester, Amanda J. Nickel, David Watson, Gloria Swanson, Jennifer C. Laine, Kelly R. Bergmann
Pediatrics Feb 2021, 147 (2) e20200118; DOI: 10.1542/peds.2020-0118
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