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. 2017 Jun 2;2(3):e026.
doi: 10.1097/pq9.0000000000000026. eCollection 2017 May-Jun.

Long-Term Sustainability of Timely Emergency Department Analgesia for Fractures: A Time Series Study

Emily C Sterrett  1 , Eileen Murtagh Kurowski  1 , Terri L Byczkowski  1
Affiliations

Long-Term Sustainability of Timely Emergency Department Analgesia for Fractures: A Time Series Study

Emily C Sterrett et al. Pediatr Qual Saf. .

Abstract

Objectives: To determine the long-term sustainability and unintended consequences of a quality improvement project to improve the timeliness of intravenous (IV) opioid administration to patients with long-bone extremity fractures within a dynamic pediatric emergency department.

Methods: A retrospective study of patients with long-bone extremity fractures was conducted using electronic medical record data from 2007 to 2014. The primary outcome was the percentage of patients receiving timely IV opioids. Control charts and time series models were used to determine if changes in the clinical microenvironment were associated with shifts in the outcome measure. Unintended consequences included patients receiving potentially avoidable IVs and use of the quality improvement process for patients without long-bone extremity fractures.

Results: Improved timeliness of IV opioids was sustained. The type of physician who staffed the process and optimization of faculty staffing hours were associated with a 9.6% decrease and 11.8% increase in timely IV opioids, respectively. Implementation of the IV opioid process was not associated with increased placement of potentially avoidable IVs. Of patients receiving the IV opioid process, 22% did not have a long-bone extremity fracture, of whom 91% were diagnosed with a different painful injury.

Conclusion: Sustainability of IV opioid timeliness was robust, despite changes in the clinical microenvironment. Changes in physician staffing and responsibilities in a pediatric emergency department may be especially important to consider when planning future improvement initiatives. Our findings support the importance of higher reliability interventions, such as identification and utilization of existing patterns of behavior, as high yield for sustaining outcomes.

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Figures

Fig. 1.
Fig. 1.
Process map for IV opioid process.
Fig. 2.
Fig. 2.
Proportion of patients with long-bone extremity fractures who received their first dose of IV opioid within 45 minutes of arrival (p-chart).
Fig. 3.
Fig. 3.
Proportion of patients with long-bone extremity fractures who received IV access for 1 dose of opioid (p-chart).
See this image and copyright information in PMC

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