Hatcliffe Rachel, Ciriello Anne, Murphy Waibel Elizabeth, Colson Cindy, White Ashley, Fritzeen Jennifer, Isbey Sarah
From the Pediatric Emergency Department, Children's National Hospital, Washington, D.C.
Department of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C.
Pediatr Qual Saf. 2025 Apr 16;10(3):e806. doi: 10.1097/pq9.0000000000000806. eCollection 2025 May-Jun.
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.
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.
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.
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.
小儿烧伤治疗向门诊护理的转变，使护理人员在伤口护理和后续规划方面承担了更大的责任。不遵守烧伤护理和后续预约可能会导致负面的情绪和身体健康结果。家长教育和换药时的疼痛控制都是遵守门诊护理的重要因素。这个单中心质量改进项目旨在改善从急诊科出院的小儿烧伤患者获得正确指导手册的情况，以及提高符合条件的患者在首次门诊预约时开具用于术前用药的羟考酮的比例。
一个多学科团队使用鱼骨图回顾性地检查障碍，绘制关键驱动因素图，并设计干预措施，包括更新定制说明、印刷出院手册、电子病历更改、增强电子处方获取、链接国际疾病分类第十版编码、有针对性地向提供者反馈以及开展教育课程。我们使用统计过程控制图跟踪每月数据。
在基线时，46%的患者收到了正确的出院资料包；经过干预后，我们观察到中心线转移至78%，且持续改善。70%符合条件的患者在基线时在门诊随访前收到了用于术前用药的羟考酮处方，干预后我们看到持续向93%的基线转移。
经过多次有针对性的干预后，定制烧伤出院指导手册和羟考酮处方的使用持续改善。未来的研究应检查出院指导和羟考酮处方对门诊预约安排及时性和疼痛评分的影响。
