807 - Quality Improvement in the Pediatric Emergency Department: Adherence to New Guidelines

Poster Board #: 807
Publication #: EP-130.807

Background: In 2018, the American Academy of Pediatrics (AAP) released maintenance intravenous fluid (IVF) guidelines for children between the ages of 28 days old and 18 years old. The recommendations were that isotonic maintenance IVFs were appropriate for most children. While adopting new guidelines often is not immediate, collaborating with all the stakeholders impacted by the guidelines and disseminating the guidelines in an efficient and convenient manner can improve compliance.


Objective: To educate all pediatric emergency department (PED) staff (attendings, trainees, and nurses) about the newly published AAP maintenance IVF guidelines in order to enhance compliance with them. We believed that, by following established and proven quality improvement strategies, we would be able to expedite adherence to the new guidelines.


Design/Methods: First, we created a team of PED attendings, fellows, and nurses. Using the Plan-Do-Study-Act (PDSA) model, we first emailed all the PED attendings and fellows the new AAP guidelines. Then, the team took the 10-page maintenance IVF guidelines and created a condensed two-page summary which highlighted the pertinent information. This summary was emailed to the physicians working in the PED and was posted throughout the PED. Finally, we emailed our summary to all the nurses in the emergency department. For patients who did not meet exclusion criteria, we collected data before and after our interventions about which type of maintenance IVFs were ordered. This study was Institutional Review Board exempt.


Results: After the new guidelines were emailed to the PED attendings and fellows, the recommended maintenance IVFs were ordered occasionally. It was not until our second intervention, the emailing and posting of our summary document, that we saw a significant shift. After the summary was distributed to the nursing staff, which was our third intervention, we noted sustained compliance with the new AAP guidelines.

Conclusion(s): Using the PDSA model, our team was able to foster compliance with the 2018 AAP maintenance IVF guidelines. This project illustrates the benefits of collaborating with a variety of staff members and including all the key stakeholders when working on a quality improvement project. It is our hope that this project will encourage further quality improvement projects in our PED.

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Authors/Institutions: Adam J. Rhodes, Maimonides Medical Center, Staten Island, New York, United States; Millicent C. Okereke, Maimonides Medical Center, Brooklyn, New York, United States; Jonathan M. Rochlin, Maimonides Medical Center, Staten Island, New York, United States; Hector Vazquez, Maimonides Medical Center, Staten Island, New York, United States