Improving Care and Outcomes for Pediatric Musculoskeletal Infections

BACKGROUND: Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% sedations per patient, and (3) empirical vancomycin administration. METHODS: We implemented 4 prospective QI interventions at tertiary children’s hospital: provider education, centralization admission location, coordination radiology-orthopedic communication, (4) implementation an MSKI algorithm order set. included patients 6 18 years age acute osteomyelitis, septic arthritis, or pyomyositis excluded complex chronic conditions ICU admission. used statistical process control charts analyze outcomes over 2 general periods: baseline (January 2015–October 17, 2016) (October 18, 2016–April 2019). RESULTS: In total, 224 included. The mean was 6.1 years, there no substantive demographic clinical differences between groups. There 81% relative PICC use (centerline shift 54%–11%; 95% confidence interval 70–92) 33% patient 1.8–1.2; 21–46). Empirical did not change 20%). CONCLUSIONS: Our multidisciplinary significant decrease PICCs but