2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T9b3,Pediatric medication dosing errors are common in the prehospital setting, particularly during high-acuity, low-frequency events requiring weight-based calculations. Evidence-based guidelines recommend standardized weight estimation, volume-based dosing, use of cognitive offload tools, and clinician training to reduce errors. We sought to implement these guidelines across an emergency medical services (EMS) system with the aim of ≥95% correct dosing for initial pediatric medication administration. This quality improvement initiative was conducted amongst multiple agencies within a single EMS system serving upstate New York and guided by the Model for Improvement. Baseline dosing accuracy for patients aged ≤13 years was calculated using registry data from 2020-2022. Interventions included implementation of a protocol-integrated, volume-based dosing application; standardized length-based weight estimation; and case-based, hands-on training. Monthly performance was monitored using Shewhart p-charts to measure % correct dosing for all medications and using Individual (I) charts to measure the degree of variability from goal midazolam dosing for seizures. Ongoing case review was used to identify sources of error and inform iterative interventions, including targeted retraining and redesign of how medications were represented within the application. Correct dosing at baseline from 2020-2022 was 79% overall, with substantial variability by medication. Midazolam for pediatric seizure was the most frequently incorrectly dosed medication at baseline (65% correct). Initial improvements were observed following implementation, with median correct dosing increasing to 91% beginning in Fall 2023. Subsequent protocol changes introduced new variation, particularly related to route-specific midazolam dosing. Targeted retraining and human-centered redesign of dose presentation within the application were associated with further improvement. Sustained process improvement to 97% correct dosing for all first-dose medications was achieved by December 2025. Improving pediatric medication safety in EMS requires a comprehensive, collaborative, and iterative quality management approach. Sustained high performance was achieved through continuous monitoring, targeted intervention, and system-level collaboration, demonstrating that implementation of evidence-based tools must be paired with ongoing quality infrastructure to achieve reliable and durable improvement.31:T7ec,The lack of centralized pediatric critical care data in Kuwait has limited benchmarking, outcome evaluation, and resource planning. This study describes the development and implementation of Kuwait's first nationwide PICU registry and evaluates its feasibility and early utility. A centralized registry was implemented across seven governmental PICUs serving over 870,000 children. Demographics, diagnoses, interventions, outcomes, and infection data were retrospectively collected at discharge by site coordinators. Data were entered into a secure, encrypted platform using de-identified records and role-based access, with centralized validation performed every tercile. During the implementation phase, 2086 of 2364 admissions were captured. Registry accuracy compared with manual admission logs was 88.2%, demonstrating feasibility and data reliability. Inter-hospital variability in clinical practices and resource utilization was identified. The registry also enabled early detection of infection trends and supported proactive staffing and equipment planning. Kuwait's national PICU registry is feasible, reliable, and operationally effective. It addresses critical data gaps, enhances transparency, supports evidence-based decision-making, and provides a foundation for national quality improvement and future benchmarking initiatives. Demonstrates feasibility, reliability, and operational effectiveness of a national PICU registry in real-world pediatric critical care. Enables early detection of infection trends and supports strategic planning for staffing and equipment. Presents one of the first national PICU registry models in the Middle East, addressing fragmented data systems. Offers practical strategies for standardization, data validation, and inter-hospital coordination, supported by physician champions and stakeholder engagement. Bridges critical data gaps, strengthens quality monitoring and benchmarking, and provides a scalable framework for broader pediatric specialties and international research.32:T975,The substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization. To optimize preference cards based on historical supply use captured through surgical receipts. This quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024. Separate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure. The number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels. A total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction. Optimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level.33:Te4a, Importance The substantial variation and excess of supplies requested by surgeons for each case using surgical preference cards represents an opportunity for cost reduction through optimization. Objective To optimize preference cards based on historical supply use captured through surgical receipts. Design, Setting, and Participants This quality improvement study took place in a large, tertiary, multi-hospital academic health system from January 1, 2019, through December 31, 2023. It included urology, colorectal, and surgical oncology services. These data were analyzed from January 2024 to August 2024. Exposures Separate linear time-series ordinary least squares regression models were fit for each surgical receipt item to estimate the optimal number of that item based on data from past cases between January 1, 2019, and December 31, 2023. Optimal surgical preference cards were constructed and compared after collating item-level estimates by optimizing items listed on existing surgical preference cards, creating new preference cards for each procedure, and creating new preference cards that stratify existing preference cards by procedure. Main outcome and measures The number of unique and total items on the cards before and after optimization were calculated at the 3 levels. Baseline waste was estimated in existing preference cards as the difference between the total cost of all items on the current surgical preference card and total cost of the surgical receipt associated with the case, averaged across all eligible cases from January 1, 2024, to May 31, 2024. Baseline waste was also compared against the estimated waste, using the optimized surgical preference card at each of the 3 levels. Results A total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card–procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction. Conclusions and Relevance Optimization of surgical preference cards with regression models has the potential to reduce surgical waste, with the greatest reduction in waste seen with optimizing existing cards after stratifying at the procedure level. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Quality Improvement Study: study design Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Quality Improvement Study (study design). Clinician-written summaries and actionable practice insights. Updated daily.\",\"url\":\"https://www.reachrx.ai/hub/tag/study_design/Quality%20Improvement%20Study\",\"breadcrumb\":{\"@type\":\"BreadcrumbList\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https://www.reachrx.ai\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Research Hub\",\"item\":\"https://www.reachrx.ai/hub\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Study Designs\",\"item\":\"https://www.reachrx.ai/hub/tag/study_design\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Quality Improvement Study\",\"item\":\"https://www.reachrx.ai/hub/tag/study_design/Quality%20Improvement%20Study\"}]}}"}}]],["$","$L2f",null,{"title":"Quality Improvement Study: Research & Clinical Takeaways","description":"Browse Quality Improvement Study research papers with clear, practical takeaways for your clinical practice.","papers":[{"doi":"10.1038/s41372-026-02725-7","pmid":"42697944","title":"Creation & implementation of discharge guidelines for preterm infants with bronchopulmonary dysplasia","journal_title":"Journal of Perinatology","journal_issn":"0743-8346","published_at":"2026-09-04T00:00:00.000Z","url":"https://doi.org/10.1038/s41372-026-02725-7","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-11T06:20:07.451Z","updated_at":"2026-09-11T06:20:07.451Z","tags":[{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"age_group","value":"neonate","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"condition","value":"Bronchopulmonary Dysplasia","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"modality","value":"Discharge Planning Protocol","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"modality","value":"Supplemental Oxygen","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"warning","value":"Clinical outcomes (e.g., readmissions, ED visits, respiratory events) are not reported — only process measures are described.","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"warning","value":"No sample size (total N) is reported in the abstract or results; the sample_size tag could not be populated.","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"warning","value":"Sex distribution of the study population is not explicitly stated; 'mixed' is assumed for NICU infants.","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02725-7","tag_type":"warning","value":"Study design is described as a quality improvement initiative; it is not a controlled trial, which limits causal inference.","value_numeric":null}],"summaries":{"key_result":"Implementation of the SAFER framework significantly improved the mean discharge score from 3.0 to 3.9, and reduced time to outpatient pulmonology follow-up from 42.7 days to 25.1 days post-discharge.","what_studied":"This quality improvement study evaluated the impact of BPD Discharge Guidelines and a five-criteria 'SAFER' Discharge Score on standardizing discharge planning for preterm infants with bronchopulmonary dysplasia (BPD) requiring respiratory support in the NICU, from January 2021 to December 2022.","limitations":"Single-center quality improvement project limits generalizability; the abstract does not report patient-level clinical outcomes (e.g., readmission rates, respiratory events); no control group or randomization was used.","practice_takeaway":"A structured five-point discharge checklist (pulmonology consult, action plan, scheduled follow-up, caregiver oxygen education, repeat chest X-ray) can meaningfully shorten the gap to specialist follow-up for BPD infants — cutting wait time nearly in half. NICUs caring for BPD patients on respiratory support should consider adopting a similar standardized discharge framework to reduce care variability during the NICU-to-home transition."}},{"doi":"10.1001/jamasurg.2026.3007","pmid":"42525407","title":"Artificial Intelligence–Driven Video-Based Surgical Skill Assessment in Hepatobiliary Laparoscopic Surgery","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-07-29T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13420149/","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-08T13:23:28.362Z","updated_at":"2026-08-08T13:23:28.362Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"condition","value":"Laparoscopic Cholecystectomy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"modality","value":"Artificial Intelligence / Computer Vision","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"warning","value":"Age group, sex, and sample size tags omitted entirely due to insufficient data in the abstract.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"warning","value":"Full text is embargoed until July 29, 2027 — only the abstract is available. Key results, sample size, comparators, and outcome data could not be extracted.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.3007","tag_type":"warning","value":"Study design labeled as 'Quality Improvement Study' per abstract; standard evidence hierarchy placement (level 4) is approximate given limited available detail.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement study evaluating a video-based AI framework using multi-instrument tracking and spatiotemporal kinematic features to objectively assess surgical skill in laparoscopic cholecystectomy.","limitations":"Full text is under embargo until July 29, 2027; only the abstract is publicly available, preventing extraction of specific results, sample sizes, or detailed methodology."}},{"doi":"10.1136/bmjpo-2026-004840","pmid":"42448611","title":"Quality improvement: prevention of cardiac arrest in children with heart disease on the paediatric intensive care unit","journal_title":"BMJ Paediatrics Open","journal_issn":"2399-9772","published_at":"2026-07-14T00:00:00.000Z","url":"https://doi.org/10.1136/bmjpo-2026-004840","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-23T13:33:24.894Z","updated_at":"2026-07-23T13:33:24.894Z","tags":[{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"condition","value":"Acute Heart Failure","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"condition","value":"Cardiac Arrest","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"condition","value":"Congenital Heart Disease","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"generic","value":"epinephrine","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"modality","value":"Quality Improvement Bundle","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"sample_size","value":"n=1113","value_numeric":1113},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"warning","value":"Enrolment into the CAP-QI bundle was low among cardiac medical admissions (16.1%), which may have diluted the bundle's effect in that subgroup — it is unclear how much is due to under-enrolment vs. true ineffectiveness of the bundle.","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"warning","value":"The overall CA rate reduction (30%) did not reach statistical significance (p=0.212), though the surgical subgroup showed statistically robust improvement by RSPRT. Clinical and statistical significance should be interpreted separately.","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"warning","value":"The PC4 risk adjustment algorithm includes variables (STS risk factors, STAT scores, timing of intubation) not routinely collected in the UK, limiting direct applicability of the risk model in other UK centres.","value_numeric":null},{"paper_doi":"10.1136/bmjpo-2026-004840","tag_type":"warning","value":"The study is non-randomised and single-centre; secular trends or unmeasured confounders cannot be excluded.","value_numeric":null}],"summaries":{"what_studied":"A cardiac arrest (CA) prevention bundle (CAP-QI) was implemented at a single UK tertiary PICU from August 2023 in children with primary cardiac diagnoses (surgical and medical) perceived to be at high CA risk, with a 1-year retrospective baseline (n=1113 total; 449 pre-, 664 post-intervention) and continuous risk-adjusted monitoring using resetting sequential probability ratio tests (RSPRT).","key_result":"Crude CA rate fell from 6.2% (28/449) pre-intervention to 4.4% (29/664) post-intervention (30% relative reduction; p=0.212 overall). In the surgical subgroup, the RSPRT 99% halving boundary was crossed within 200 admissions, confirming special-cause variation; surgical CA dropped from 5.2% to 2.9%. No significant reduction occurred in cardiac medical admissions (9.0% vs 8.0%). ECMO and ECPR rates were unchanged.","limitations":"Single-centre, non-randomised design with susceptibility to unmeasured confounding. The bundle was ineffective in cardiac medical patients, partly due to low enrolment (16.1% of medical admissions enrolled). Sustainability beyond the study period has not yet been established.","practice_takeaway":"Consider implementing a structured CA prevention bundle—including twice-daily safety huddles, proactive high-risk designation, and bedside low-dose epinephrine—for post-cardiac-surgery patients in PICU; evidence of benefit is strongest in this surgical group. Medical cardiac admissions, especially those with acute heart failure, need refined enrolment criteria and better-calibrated risk models before similar gains can be expected."}},{"doi":"10.1007/s43678-026-01229-9","pmid":"42435275","title":"Provision of timely follow-up and understanding service demand for pediatric emergency department patients with a mental health concern: a quality improvement initiative","journal_title":"Canadian Journal of Emergency Medicine","journal_issn":"1481-8035","published_at":"2026-07-11T00:00:00.000Z","url":"https://doi.org/10.1007/s43678-026-01229-9","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-18T13:39:44.601Z","updated_at":"2026-07-18T13:39:44.601Z","tags":[{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"condition","value":"Pediatric Mental Health Crisis","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"modality","value":"Mental Health Follow-Up Care","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"sample_size","value":"n=431","value_numeric":431},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"warning","value":"Full text was not available; some methodological details (e.g., patient eligibility criteria, proportion offered vs. accepting appointments) could not be verified from the abstract alone.","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"warning","value":"Only two of eight sites contributed follow-up timing data; the remaining six sites provided visit volume data only, so the 431-patient sample reflects those two sites. Generalizability to other settings is uncertain.","value_numeric":null},{"paper_doi":"10.1007/s43678-026-01229-9","tag_type":"warning","value":"Study design is labeled 'Quality Improvement Initiative' (Brief Quality Report); it lacks a control group, so causal inferences about the intervention's effect cannot be drawn.","value_numeric":null}],"summaries":{"what_studied":"This quality improvement initiative evaluated whether two Canadian pediatric EDs could provide mental health follow-up appointments within 96 hours of discharge to 100% of eligible children lacking existing mental health access; six additional sites contributed demand pattern data across 8 total sites.","key_result":"Of 431 children given follow-up appointments, only 75% at site A and 62% at site B received them within the 96-hour target — falling short of the 100% aim. Patients presenting Wednesday–Friday were least likely to meet the target (p < 0.001). Across all 8 sites, ED mental health visits were lowest on weekends and in July–August (p < 0.001).","limitations":"Only two sites collected appointment timing data, limiting generalizability. The study did not report clinical outcomes (e.g., re-presentation, harm) tied to follow-up timeliness. Eligibility criteria and how many patients were offered but declined appointments are not detailed in the abstract.","practice_takeaway":"Schedule more mental health follow-up slots on Mondays and Tuesdays to catch patients who present Wednesday–Friday and need an appointment within 96 hours. Recognize that weekends and summer months bring lower ED mental health volume, which can inform staffing and capacity planning."}},{"doi":"10.1097/pec.0000000000003650","pmid":"42400418","title":"Using Quality Improvement Methodology to Inform Safe Implementation of Propofol Procedural Sedation in a Pediatric Emergency Department","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-07-07T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003650","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-12T13:19:45.643Z","updated_at":"2026-07-12T13:19:45.643Z","tags":[{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"condition","value":"Procedural Sedation","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"generic","value":"ketamine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"generic","value":"propofol","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"modality","value":"Procedural Sedation Agent","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"sample_size","value":"n=2368","value_numeric":2368},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"warning","value":"Propofol adoption rate was low (4.9% overall), which may reflect early implementation phase rather than steady-state practice, limiting long-term generalizability.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"warning","value":"SAE definition is limited to airway-related events; other adverse event types may not be fully captured.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003650","tag_type":"warning","value":"Study design is QI (non-randomized, non-controlled); propofol was restricted to selected low-risk patients, so comparisons with ketamine are subject to significant selection bias.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement (QI) initiative across 4 pediatric EDs used the DMAIC framework to safely introduce a standardized propofol procedural sedation protocol for short procedures in low-risk pediatric patients, comparing outcomes (sedation duration, ED LOS, serious adverse events) against ketamine.","key_result":"Propofol sedation was significantly shorter than ketamine (18–24 vs. 33–52 min across sites; P < 0.001), with shorter ED LOS at two sites. Propofol-associated serious adverse events (SAEs) occurred in 2.6% of cases; overall SAE rates remained low and stable. Propofol represented 4.9% of all sedations and 20% of eligible-patient sedations (117 of 2,368 total).","limitations":"Propofol uptake was low (4.9% of all sedations), limiting generalizability of outcomes; no randomization means selection bias is likely since propofol was restricted to low-risk, short-procedure patients. The study is a single-network QI initiative without a concurrent control group.","practice_takeaway":"A structured DMAIC-based protocol — including simulation training, EMR order sets, and phased rollout — can safely introduce propofol sedation in pediatric EDs with low SAE rates. For eligible low-risk patients undergoing short procedures, propofol offers meaningfully shorter sedation time and ED stay compared with ketamine."}},{"doi":"10.1016/j.acap.2026.103377","pmid":"42365911","title":"A Simple Health-Related Social Needs Referral Workflow in a Pediatric Emergency Department","journal_title":"Academic Pediatrics","journal_issn":"1876-2859","published_at":"2026-06-28T00:00:00.000Z","url":"https://doi.org/10.1016/j.acap.2026.103377","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-06T13:36:13.568Z","updated_at":"2026-07-06T13:36:13.568Z","tags":[{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"condition","value":"Health-Related Social Needs","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"modality","value":"Social Needs Screening and Referral","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"sample_size","value":"n=229","value_numeric":229},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"warning","value":"Age group is mixed: patients >17 years were contacted directly, while caregivers were contacted for patients ≤17 years, potentially introducing heterogeneity in responses.","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"warning","value":"Follow-up rate was only 44.1%, meaning results reflect a self-selected subset; true population-level connection rates are likely lower.","value_numeric":null},{"paper_doi":"10.1016/j.acap.2026.103377","tag_type":"warning","value":"Study design is labeled as a quality improvement initiative, which differs from a prospective cohort or RCT — causal inferences are limited.","value_numeric":null}],"summaries":{"what_studied":"This quality improvement study evaluated the rate at which families with unmet health-related social needs (HRSN) in a Pediatric Emergency Department (PED) successfully connected with social services via an automated EHR-based referral workflow — resource guides printed automatically with discharge summaries — over a 6-month period (March–August 2025).","key_result":"Of 229 eligible families, 101 (44.1%) completed follow-up surveys; 22.8% (23/101) successfully connected with a social service. Only 46.5% recalled receiving the resource guide, and 25.8% found it helpful. The most common barrier to connection was losing the contact information (n=36, 64.4% of non-attempters).","limitations":"- Low follow-up survey completion rate (44.1%) introduces response bias and likely overestimates true connection rates.\n- Single-site PED study limits generalizability.\n- Self-reported outcomes via telephone survey are subject to recall bias (only 46.5% remembered receiving the guide).","practice_takeaway":"A simple, automated print-at-discharge HRSN resource guide connected roughly 1 in 4 families who completed follow-up — a modest but meaningful rate for a low-burden intervention. Addressing the top barrier (losing contact info) through digital delivery or active follow-up may meaningfully improve connection rates."}},{"doi":"10.1097/pec.0000000000003640","pmid":"42299025","title":"Improving Naloxone and Buprenorphine Provision in the Pediatric Emergency Department Through Education and Chief Complaint-Triggered Screening","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-06-16T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003640","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:24:59.796Z","updated_at":"2026-06-20T13:24:59.796Z","tags":[{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"condition","value":"Opioid Overdose","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"condition","value":"Opioid Use Disorder","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"generic","value":"buprenorphine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"generic","value":"naloxone","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"modality","value":"Opioid Antagonist","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"modality","value":"Partial Opioid Agonist","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"sample_size","value":"n=309","value_numeric":309},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"Sample size of 309 reflects medication recipients only, not total encounters analyzed over 45 months; the denominator for all PED visits is not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"Study design is labeled QI (quality improvement), which lacks a concurrent control group; pre-post comparisons may be subject to secular trend bias.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"The full text was not accessible — only the abstract was available for extraction. Statistical significance, confidence intervals, and detailed demographic breakdowns could not be verified.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003640","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously given the single-site, non-randomized design, but the intervention represents a scalable, EHR-integrated model with clear outcome improvements.","value_numeric":null}],"summaries":{"practice_takeaway":"Embedding chief complaint–triggered electronic alerts with provider education in a PED can meaningfully raise naloxone and buprenorphine provision for at-risk adolescents without driving more return visits. EDs caring for adolescents should consider implementing similar BPA-driven OUD screening pathways.","what_studied":"This quality improvement (QI) initiative evaluated whether electronic Best Practice Alerts (BPAs) triggered by specific chief complaints — combined with provider education, formulary changes, and clinical pathways — could increase naloxone dispensing and buprenorphine prescribing for adolescents with opioid use disorder (OUD) in a pediatric emergency department (PED) over a 45-month period.","key_result":"Among patients with BPA-qualifying chief complaints, naloxone dispensing rose from 3.89% to 11.39% and buprenorphine prescribing rose from 1.04% to 2.46% post-implementation; overall naloxone prescribing across all PED visits increased from 0.40% to 0.79%. In total, 63 adolescents initiated buprenorphine and 246 received naloxone. Black/African American adolescents and those with government insurance received more medications post-implementation. BPA-triggered encounters had longer ED stays but no increase in return visits.","limitations":"Single-site QI study limits generalizability. The full-text was not accessible for review — findings are drawn from the abstract alone, so confounders and statistical significance details are unavailable. Absolute prescribing rates remain low even post-intervention, suggesting substantial room for improvement."}},{"doi":"10.1097/pec.0000000000003641","pmid":"42308170","title":"Optimizing a Level 1 Trauma Pediatric Emergency Department Tracking Board—A Quality Improvement Initiative","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003641","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-22T13:24:10.597Z","updated_at":"2026-06-22T13:24:10.597Z","tags":[{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"condition","value":"Pediatric Emergency Department Throughput","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"modality","value":"Health Information Technology","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"sample_size","value":"n=68979","value_numeric":68979},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"warning","value":"Before-after design cannot rule out secular trends or concurrent operational changes as contributors to the observed improvements.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"warning","value":"The full text PDF was not accessible — only the abstract and results section were available; methodological details (e.g., exact statistical models, provider stratification breakdowns) could not be verified.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003641","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the magnitude and statistical significance of findings, but causal attribution is limited by the non-randomized design.","value_numeric":null}],"summaries":{"what_studied":"This quality improvement study evaluated whether optimizing an electronic ED tracking board (removing 8 nonpertinent columns; adding vital signs, bed status, floor orders, and unassigned-patient visibility) was associated with improved throughput metrics in a Level 1 trauma pediatric ED, comparing pre- vs. post-intervention periods across 68,979 encounters from April 2022 to March 2024.","key_result":"LWBS rates dropped from 13.9% to 6.9% (P<0.001); door-to-doc time fell from 82.9 to 59.1 min; room-to-doc time from 9.8 to 7.2 min; and total ED LOS from 318.9 to 296.5 min (all P<0.001) — improvements persisted after adjustment for volume, acuity, provider coverage, and month. No significant change in doc-to-disposition or bed-to-admit times.","limitations":"Single-center, before-after design limits causal inference and generalizability. The tracking board change co-occurred with other unmeasured operational factors that could confound results. Full text was not accessible for detailed methodological review.","practice_takeaway":"Redesigning the ED tracking board — cutting clutter and surfacing actionable data — was linked to a 50% drop in LWBS rates and a 23-minute reduction in door-to-doc time. This is a low-cost, broadly applicable intervention worth testing in other pediatric EDs."}},{"doi":"10.1097/pec.0000000000003639","pmid":"42290282","title":"A 100-Day Workout Quality Improvement Project to Improve Value for the Care of Mental Health Conditions in a Pediatric Emergency Department","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-06-15T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003639","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-21T13:29:52.755Z","updated_at":"2026-06-21T13:29:52.755Z","tags":[{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"condition","value":"Behavioral And Mental Health Conditions","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"condition","value":"Pediatric Psychiatric Emergency","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"modality","value":"Clinical Pathway / Low-Value Care Reduction","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"warning","value":"Full text was inaccessible; the extracted PDF contained only publisher permission guidelines, not the article body. All structured data is derived solely from the abstract.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"warning","value":"Sample size (total N) is not reported in the abstract and could not be tagged.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"warning","value":"Sex breakdown of the study population is not reported.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003639","tag_type":"warning","value":"The 10% cost reduction figure may reflect institution-specific pricing and may not generalize to other centers.","value_numeric":null}],"summaries":{"what_studied":"A 100-day Lean Six Sigma quality improvement initiative in a pediatric ED aimed to reduce unnecessary (low-value) routine laboratory testing for children admitted to inpatient psychiatry, targeting a ≥25% reduction in unnecessary testing and costs.","key_result":"Routine laboratory testing dropped from 96% to 20.8% post-implementation. Overall costs for psychiatry admissions fell by 10%, with no adverse clinical outcomes reported.","limitations":"Full text was not accessible beyond the abstract; sample size, comparator period length, and specific clinical outcomes tracked are not reported. Single-institution study limits generalizability.","practice_takeaway":"Implementing an evidence-based clinical pathway using Lean Six Sigma can dramatically cut unnecessary lab testing in pediatric ED patients with behavioral/mental health complaints—from nearly universal to about 1 in 5 patients—without harming outcomes. Pediatric EDs should consider similar structured pathways to reduce low-value care for this population."}},{"doi":"10.1001/jamaophthalmol.2026.1930","pmid":"42275073","title":"STROBE Guideline Adherence Among Ophthalmology Journals","journal_title":"JAMA Ophthalmology","journal_issn":"2168-6165","published_at":"2026-06-11T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13261508/","source_score":3,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-16T13:54:25.107Z","updated_at":"2026-06-16T13:54:25.107Z","tags":[{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"category","value":"Ophthalmology","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"condition","value":"Ophthalmology Reporting Quality","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"warning","value":"Full text was inaccessible — only the abstract was available. Key results, sample size, specific adherence rates, and study conclusions could not be extracted or verified.","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"warning","value":"Level of evidence assigned as 4 (observational/descriptive) due to the nature of a reporting adherence audit; this is an estimate pending full-text review.","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2026.1930","tag_type":"warning","value":"Study design labeled as 'Quality Improvement Study' per the abstract; this may reflect a bibliometric or audit methodology rather than a traditional clinical study design.","value_numeric":null}],"summaries":{"what_studied":"This quality improvement study assessed how well observational studies published in three major ophthalmology journals (American Journal of Ophthalmology, JAMA Ophthalmology, and Ophthalmology) adhere to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist items.","limitations":"Only the abstract was available for extraction; full-text data including sample size, specific adherence rates, and study-level findings could not be verified.","practice_takeaway":"Clinicians and researchers submitting observational studies to ophthalmology journals should proactively use the STROBE checklist to improve reporting quality and transparency."}},{"doi":"10.1136/emermed-2025-215411","pmid":"42264914","title":"Same day emergency care for low back pain: quality improvement to support emergency flow and reduce unnecessary acute admissions","journal_title":"Emergency Medicine Journal","journal_issn":"1472-0205","published_at":"2026-06-09T00:00:00.000Z","url":"https://doi.org/10.1136/emermed-2025-215411","source_score":6,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-14T13:34:53.882Z","updated_at":"2026-06-14T13:34:53.882Z","tags":[{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"condition","value":"Low Back Pain","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"modality","value":"Same Day Emergency Care Pathway","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"sample_size","value":"n=3921","value_numeric":3921},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"No control group or comparator site; admission rate reductions may partly reflect system learning or case-mix changes over time rather than the pathway alone.","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"Patient safety outcomes such as missed serious pathology, readmissions, or 30-day mortality are not reported, limiting conclusions about safety of the reduced admission rate.","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"Study spans 2018–2021, including the COVID-19 pandemic period, which may have affected referral volumes and admission thresholds in ways not fully accounted for.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement (QI) project evaluated a same day emergency care (SDEC) pathway for low back pain (LBP) in an ED setting over four PDSA cycles from November 2018 to December 2021, aiming to reduce avoidable hospital admissions.","key_result":"Across 3,921 total referrals, hospital admission rates fell from 31% in early cycles to 8% by cycle 4 (n=172/2,042), while same-day MRI utilisation stabilised at 11% — without an apparent increase in overall MRI demand.","limitations":"Single-centre QI project without a control group; no formal ethical review or randomisation; long-term follow-up outcomes (e.g., readmissions, patient safety) are not reported.","practice_takeaway":"An ED-based spinal SDEC pathway staffed by specialist nurses and advanced physiotherapists can cut LBP admission rates from ~31% to ~8% over time. Embedding iterative feedback cycles and stakeholder co-design appears key to sustaining these gains."}},{"doi":"10.1016/j.resuscitation.2026.111141","pmid":"42167583","title":"Integrated CPR Coach and Compressor Training Improves CPR Quality in a Pediatric Emergency Department","journal_title":"Resuscitation","journal_issn":"0300-9572","published_at":"2026-05-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.resuscitation.2026.111141","source_score":1,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-26T13:35:00.803Z","updated_at":"2026-05-26T13:35:00.803Z","tags":[{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"age_group","value":"child","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"age_group","value":"infant","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"condition","value":"Pediatric Cardiac Arrest","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"modality","value":"CPR / Cardiopulmonary Resuscitation","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"modality","value":"Simulation-Based Training","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"sample_size","value":"n=106","value_numeric":106},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"warning","value":"140 total cardiac arrest patients were screened but only 106 included; exclusion criteria are not detailed in the abstract, which may introduce selection bias.","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"warning","value":"Depth compliance improvement was not observed in children and adolescents — age-group subgroup findings should be interpreted carefully given small subgroup sizes (n=24 children, n=28 adolescents).","value_numeric":null},{"paper_doi":"10.1016/j.resuscitation.2026.111141","tag_type":"warning","value":"Impact flag 'practice_changing' applied cautiously — results are from a single-center QI study without a control group; causality cannot be firmly established.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement study in a pediatric emergency department evaluated a multimodal intervention — CPR coach simulation curriculum, compressor training, and metronome-guided feedback — on CPR quality metrics (chest compression depth, rate, and fraction) during pediatric cardiac arrest from October 2022 to December 2025.","key_result":"Across 106 included patients, median depth compliance improved from 14% to 61%, median rate compliance from 69% to 80%, and chest compression fraction (CCF) was maintained at 89%; infant mean compression depth rose from 3.1 cm to 4.4 cm, though depth did not improve in children or adolescents.","limitations":"Single-center pediatric ED limits generalizability; non-randomized quality improvement design precludes causal inference; depth improvement was not demonstrated in older age groups (children and adolescents).","practice_takeaway":"Combining CPR coach simulation training with compressor training and real-time metronome feedback can substantially close the gap between baseline and AHA-recommended compression depth and rate targets in a pediatric ED. Infant-specific gains were most pronounced, so teams caring for older children may need additional targeted strategies."}},{"doi":"10.1097/pec.0000000000003605","pmid":"42108974","title":"Improving Appropriateness and Timeliness of Antibiotic Delivery in Pediatric Intestinal Failure","journal_title":"Pediatric Emergency Care","journal_issn":"0749-5161","published_at":"2026-05-11T00:00:00.000Z","url":"https://doi.org/10.1097/pec.0000000000003605","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-20T13:23:25.385Z","updated_at":"2026-05-20T13:23:25.385Z","tags":[{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"condition","value":"Central Line-Associated Bloodstream Infection","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"condition","value":"Pediatric Intestinal Failure","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"generic","value":"cefepime","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"generic","value":"ceftriaxone","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"generic","value":"vancomycin","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"modality","value":"Antibiotic Therapy","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"sample_size","value":"n=95","value_numeric":95},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"warning","value":"No clinical outcome data (e.g., CLABSI rates, mortality, length of stay) were reported, so the impact flag reflects process improvement rather than confirmed patient outcome benefit.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"warning","value":"Sex distribution was not explicitly reported in the abstract; 'mixed' is assumed for a pediatric population study.","value_numeric":null},{"paper_doi":"10.1097/pec.0000000000003605","tag_type":"warning","value":"The full text content retrieved appears to be a Lippincott author permissions page rather than the actual article body; all clinical data are drawn from the abstract and results sections only.","value_numeric":null}],"summaries":{"what_studied":"A single-center quality improvement (QI) project evaluated whether multifaceted interventions (EHR alerts, provider education, family CLABSI cards, antibiotic order sets, and ensuring cefepime availability) could improve appropriate and timely empiric antibiotic delivery in febrile pediatric intestinal failure (PIF) patients presenting to the ED from February 2020 through August 2023.","key_result":"Across 95 encounters (43 pre-, 52 post-intervention), correct antibiotic ordering (both cefepime + vancomycin) rose from 55.8% to 80.8% (P<0.01); median time to cephalosporin administration fell 58% (94.5 → 39.5 min, P<0.05); cephalosporins given within 60 minutes improved from 30.2% to 72.6% (P<0.05).","limitations":"Single-center design limits generalizability; small sample size (n=95 total encounters); no clinical outcomes (e.g., mortality, length of stay, CLABSI rates) were reported as endpoints.","practice_takeaway":"For febrile pediatric intestinal failure patients with central lines, pairing EHR order sets with provider education and ensuring cefepime is stocked in the ED can dramatically cut time to appropriate antibiotic administration. Target both antibiotic choice (cefepime + vancomycin) and administration within 60 minutes as measurable QI goals."}},{"doi":"10.1038/s41372-026-02710-0","pmid":"42082624","title":"Timely administration of antibiotics for neonatal sepsis in the neonatal intensive care unit: A quality improvement initiative","journal_title":"Journal of Perinatology","journal_issn":"0743-8346","published_at":"2026-05-05T00:00:00.000Z","url":"https://doi.org/10.1038/s41372-026-02710-0","source_score":7,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.1038/s41372-026-02710-0","days":"7","issn":"0743-8346","rank":"4","field":"Clinical Medicine","score":"7","category":"Obstetrics & Gynecology","categories":["Obstetrics & Gynecology"],"_categories":["Obstetrics & Gynecology"]},"pubmed":{"doi":"10.1038/s41372-026-02710-0","title":"Timely administration of antibiotics for neonatal sepsis in the neonatal intensive care unit: A quality improvement initiative.","journal":"Journal of perinatology : official journal of the California Perinatal Association","methods":"","results":"Infants receiving antibiotics within 60 min improved from baseline 32.7% to 84.4% over a 3 year period and has been sustained over 2 years. The average time to administration decreased from 93.3 min to 44.7 min.","abstract":"To Improve timely administration of the first antibiotic dose in the neonatal intensive care unit (NICU) through a quality improvement (QI) initiative.\nConducted in a 53- bed NICU over 3 years involving 1094 neonates who received antibiotics for suspected sepsis. Using the Institute for Healthcare Improvement (IHI) methods, three interventions were made: NICU staff education; developed order sets for stat antibiotic doses and implementation of a secure code medication delivery system. Outcomes included the infants receiving their first antibiotic dose within 60 min of ordering and average time from order to administration.\nInfants receiving antibiotics within 60 min improved from baseline 32.7% to 84.4% over a 3 year period and has been sustained over 2 years. The average time to administration decreased from 93.3 min to 44.7 min.\nA systematic multidisciplinary approach decreased the time from antibiotic order to administration time in the NICU.","keywords":[],"pubmed_id":"42082624","conclusions":"A systematic multidisciplinary approach decreased the time from antibiotic order to administration time in the NICU.","publication_date":"2026-05-05T00:00:00"},"crossref":{"DOI":"10.1038/s41372-026-02710-0","URL":"https://doi.org/10.1038/s41372-026-02710-0","ISSN":["0743-8346","1476-5543"],"link":[{"URL":"https://www.nature.com/articles/s41372-026-02710-0.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://www.nature.com/articles/s41372-026-02710-0","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://www.nature.com/articles/s41372-026-02710-0.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Timely administration of antibiotics for neonatal sepsis in the neonatal intensive care unit: A quality improvement initiative"],"author":[{"given":"Harjinder P","family":"Singh","sequence":"first","affiliation":[]},{"given":"Sheri","family":"Landazuri","sequence":"additional","affiliation":[]},{"given":"Susan","family":"Wilkinson","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,5,4]]},"member":"297","prefix":"10.1038","source":"Crossref","volume":null,"created":{"date-time":"2026-05-04T10:31:21Z","timestamp":1777890681000,"date-parts":[[2026,5,4]]},"indexed":{"date-time":"2026-05-05T03:28:36Z","timestamp":1777951716862,"date-parts":[[2026,5,5]]},"license":[{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000,"date-parts":[[2026,5,4]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000,"date-parts":[[2026,5,4]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://www.nature.com/articles/s41372-026-02710-0"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"ArticleHistory","label":"Article History"},"label":"Received","order":1,"value":"18 September 2025"},{"name":"revised","group":{"name":"ArticleHistory","label":"Article History"},"label":"Revised","order":2,"value":"20 March 2026"},{"name":"accepted","group":{"name":"ArticleHistory","label":"Article History"},"label":"Accepted","order":3,"value":"20 April 2026"},{"name":"first_online","group":{"name":"ArticleHistory","label":"Article History"},"label":"First Online","order":4,"value":"4 May 2026"},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"},"order":1,"value":"The authors declare no competing interests."}],"deposited":{"date-time":"2026-05-04T10:31:23Z","timestamp":1777890683000,"date-parts":[[2026,5,4]]},"issn-type":[{"type":"print","value":"0743-8346"},{"type":"electronic","value":"1476-5543"}],"published":{"date-parts":[[2026,5,4]]},"publisher":"Springer Science and Business Media LLC","reference":[{"DOI":"10.1128/CMR.00031-13","key":"2710_CR1","year":"2014","issue":null,"author":"KA Simonsen","volume":"27","first-page":"21","unstructured":"Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27:21–47.","article-title":null,"journal-title":"Clin Microbiol Rev","doi-asserted-by":"publisher"},{"DOI":null,"key":"2710_CR2","year":"2020","issue":null,"author":"BJ Stoll","volume":"146","first-page":"e20200334","unstructured":"Stoll BJ, Puopolo KM, Hansen NI, Sanchez PJ, Bell EF, Waldemar CA, et al. Early-onset neonatal sepsis 2015–2017. Pediatrics. 2020;146:e20200334.","article-title":null,"journal-title":"Pediatrics","doi-asserted-by":null},{"DOI":"10.1542/peds.2012-0541","key":"2710_CR3","year":"2012","issue":null,"author":"RA Polin","volume":"129","first-page":"1006","unstructured":"Polin RA. Committee on Fetus and Newborn. Management of neonates at risk for early-onset sepsis. Pediatrics. 2012;129:1006–15.","article-title":null,"journal-title":"Pediatrics","doi-asserted-by":"publisher"},{"DOI":"10.1542/peds.2021-052456","key":"2710_CR4","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Flannery DD, Edwards EM, Puopolo KM, Horbar JD. Early Onset Sepsis among very Preterm Infants. Pediatrics 2021;148:e2021052456.","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1542/peds.97.2.285a","key":"2710_CR5","year":"1996","issue":null,"author":"BJ Stoll","volume":"97","first-page":"285","unstructured":"Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Late-onset sepsis in very low birth weight neonates. Pediatrics. 1996;97:285–91.","article-title":null,"journal-title":"Pediatrics","doi-asserted-by":"crossref"},{"DOI":"10.1016/j.jpeds.2012.11.089","key":"2710_CR6","year":"2013","issue":null,"author":"NS Boghossian","volume":"162","first-page":"1120","unstructured":"Boghossian NS, Page GP, Bell EF, Stoll BJ, Murry JC, Colten CM, et al. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr. 2013;162:1120–24.e1.","article-title":null,"journal-title":"J Pediatr","doi-asserted-by":"publisher"},{"DOI":"10.1542/peds.digest1295","key":"2710_CR7","year":"2012","issue":null,"author":"CP Hornik","volume":"129","first-page":"e1","unstructured":"Hornik CP, Fort P, Clark RH, Watt K, Benjamin DK Jr, Smith PB, et al. Early and late-onset sepsis in very-low-birth-weight infants from a national cohort. Pediatrics. 2012;129:e1–e8.","article-title":null,"journal-title":"Pediatrics","doi-asserted-by":"crossref"},{"DOI":"10.1542/peds.2022-058813","key":"2710_CR8","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Flannery DD, Edwards EM, Coggins LA, Horbar JD, Puopolo KM. Late onset sepsis among very preterm infants. Pediatrics. 2022;150:e2022058813.","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1111/apa.12764","key":"2710_CR9","year":"2014","issue":null,"author":"SE Bakhuizen","volume":"103","first-page":"1211","unstructured":"Bakhuizen SE, de Haan TR, Teune MJ, Leemhuis A, Van der Heyden J, Van der Ham DP, et al. Meta-analysis shows that infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications. Acta Paediatr. 2014;103:1211.","article-title":null,"journal-title":"Acta Paediatr","doi-asserted-by":"publisher"},{"DOI":"10.1001/jamapediatrics.2020.0593","key":"2710_CR10","year":"2020","issue":null,"author":"BJ Stoll","volume":"174","first-page":"e200593","unstructured":"Stoll BJ, Puopolo KM, Hansen NI, Sanchez PJ, Bell EF, Carlo WA, et al. Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies. JAMA Pediatr. 2020;174:e200593.","article-title":null,"journal-title":"JAMA Pediatr","doi-asserted-by":"publisher"},{"DOI":"10.1007/s00134-016-4574-2","key":"2710_CR11","year":"2016","issue":null,"author":"L Morin","volume":"42","first-page":"1948","unstructured":"Morin L, Ray S, Wilson C, Remy S, Benissa MR, Jansen NJG, et al. ESPNIC Refractory Septic Shock Definition Taskforce the Infection Systemic Inflammation Sepsis section of ESPNIC. Refractory septic shock in children: A European Society of Pediatric and Neonatal Intensive Care definition. Intensive Care Med. 2016;42:1948–57.","article-title":null,"journal-title":"Intensive Care Med","doi-asserted-by":"publisher"},{"DOI":"10.1007/s00134-017-4701-8","key":"2710_CR12","year":"2017","issue":null,"author":"LJ Schlapbach","volume":"43","first-page":"1085","unstructured":"Schlapbach LJ, MacLaren G, Festa M, Alexander J, Erickson S, Beca J, et al. Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE) and Australian & New Zealand Intensive Care Society Pediatric Study Group: Prediction of pediatric sepsis mortality within 1 h of intensive care admission. Intensive Care Med. 2017;43:1085–96.","article-title":null,"journal-title":"Intensive Care Med","doi-asserted-by":"publisher"},{"DOI":"10.1097/PCC.0000000000001222","key":"2710_CR13","year":"2017","issue":null,"author":"SL Weiss","volume":"18","first-page":"823","unstructured":"Weiss SL, Balamuth F, Hensley J, Fitzgerald JC, Bush J, Nadkarni VM, et al. The epidemiology of hospital death following pediatric severe sepsis: When, why, and how children with sepsis die. Pediatr Crit Care Med. 2017;18:823–30.","article-title":null,"journal-title":"Pediatr Crit Care Med","doi-asserted-by":"publisher"},{"DOI":"10.1097/PCC.0000000000000385","key":"2710_CR14","year":"2015","issue":null,"author":"M Cvetkovic","volume":"16","first-page":"410","unstructured":"Cvetkovic M, Lutman D, Ramnarayan P, Pathan N, Inwald D, Peters MJ. Timing of death in children referred for intensive care with severe sepsis: Implications for interventional studies. Pediatr Crit Care Med. 2015;16:410–7.","article-title":null,"journal-title":"Pediatr Crit Care Med","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jpeds.2019.08.023","key":"2710_CR15","year":"2020","issue":null,"author":"M Schmatz","volume":"217","first-page":"59","unstructured":"Schmatz M, Srinivasan L, Grundmeier RW, Elsi OU, Weiss SL, Masino AJ, et al. Surviving Sepsis in a referral Neonatal Intensive Care Unit: Association between time to antibiotic administration and in-hospital outcomes. J Pediatr. 2020;217:59–65.","article-title":null,"journal-title":"J Pediatr","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.clp.2010.04.002","key":"2710_CR16","year":"2010","issue":null,"author":"JL Wynn","volume":"37","first-page":"439","unstructured":"Wynn JL, Wong HR. Pathophysiology and treatment of septic shock in neonates. Clin Perinatol. 2010;37:439–79.","article-title":null,"journal-title":"Clin Perinatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jiph.2022.05.004","key":"2710_CR17","year":"2022","issue":null,"author":"A Al Matari","volume":"15","first-page":"643","unstructured":"Al Matari A, Al Sulaiman M, Al Otaiby S, Qaraqei M, Al Matary M. Association between the timing of antibiotics administration and outcome of neonatal sepsis. J Infect Public Health. 2022;15:643–7.","article-title":null,"journal-title":"J Infect Public Health","doi-asserted-by":"publisher"},{"DOI":"10.1097/PCC.0000000000002198","key":"2710_CR18","year":"2020","issue":null,"author":"S Weiss","volume":"21","first-page":"e52","unstructured":"Weiss S, Peters M, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020;21:e52–e106.","article-title":null,"journal-title":"Pediatr Crit Care Med","doi-asserted-by":"publisher"},{"DOI":"10.1097/ANC.0b013e3182862c99","key":"2710_CR19","year":"2013","issue":null,"author":"RL Bissinger","volume":"13","first-page":"22","unstructured":"Bissinger RL, Mueller M, Cox TH, Cahill J, Garner SS, Irving M, et al. Antibiotic timing in neonates with suspected hospital-acquired infections. Adv Neonatal Care. 2013;13:22–28.","article-title":null,"journal-title":"Adv Neonatal Care","doi-asserted-by":"publisher"},{"DOI":null,"key":"2710_CR20","year":"2021","issue":null,"author":"S Ajayi","volume":"6","first-page":"3e407","unstructured":"Ajayi S, Kehinde F, Cooperberg D, Touch SM. Reducing Time to First dose of Antibiotic: The example of asymptomatic Neonates Exposed to Chorioamnionitis. Pediatr Qual Saf. 2021;6:3e407.","article-title":null,"journal-title":"Pediatr Qual Saf","doi-asserted-by":null},{"DOI":"10.3233/NPM-190293","key":"2710_CR21","year":"2020","issue":null,"author":"C Ma","volume":"13","first-page":"239","unstructured":"Ma C, Levin G, Panda SK, Sambalingam D, Singh AP. Improving timing of antibiotics in neonates with early onset sepsis-Quality Improvement project. J Neonatal Perinat Med. 2020;13:239–46.","article-title":null,"journal-title":"J Neonatal Perinat Med","doi-asserted-by":"publisher"},{"DOI":"10.1136/bmjoq-2021-001365","key":"2710_CR22","year":"2021","issue":null,"author":"R Somosri","volume":"10","first-page":null,"unstructured":"Somosri R, Venkataseshan S, Sourabh D, Kumar P. Ensuring administration of first dose of antibiotics within the golden hour of management in neonates with sepsis. BMJ Open Qual. 2021;10:e001365. https://doi.org/10.1136/bmjoq-2021-001365.","article-title":null,"journal-title":"BMJ Open Qual","doi-asserted-by":"publisher"},{"DOI":"10.1136/bmjgh-2017-000650","key":"2710_CR23","year":"2018","issue":null,"author":"HC Duber","volume":"3","first-page":"e000650","unstructured":"Duber HC, Hartford EA, Schaefer A, Johanns CK, Colombara DV, Iriarte E, et al. Appropriate and timely antibiotic administration for Neonatal sepsis in Mesoamerica. BMJ Glob Health. 2018;3:e000650.","article-title":null,"journal-title":"BMJ Glob Health","doi-asserted-by":"publisher"},{"DOI":null,"key":"2710_CR24","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Geneva World Health Organization; Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions; 2020. [Sep;2023]. https://www.who.int/publications/i/item/9789240010789","article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"update-policy":"https://doi.org/10.1007/springer_crossmark_policy","alternative-id":["2710"],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"original-title":[],"container-title":["Journal of Perinatology"],"reference-count":24,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,4]]},"references-count":24,"short-container-title":["J Perinatol"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1038/s41372-026-02710-0","is_oa":true,"title":"Timely administration of antibiotics for neonatal sepsis in the neonatal intensive care unit: A quality improvement initiative","updated":"2026-05-06T13:23:02+00:00","published_date":"2026-05-04","best_oa_location":{"url":"https://www.nature.com/articles/s41372-026-02710-0.pdf","pmh_id":null,"url_for_pdf":"https://www.nature.com/articles/s41372-026-02710-0.pdf","url_for_landing_page":"https://doi.org/10.1038/s41372-026-02710-0"}}},"created_at":"2026-05-09T13:22:29.157Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"age_group","value":"neonate","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"condition","value":"Neonatal Sepsis","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"modality","value":"Antibiotic Therapy","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"sample_size","value":"n=1094","value_numeric":1094},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"warning","value":"Clinical outcome data (mortality, length of stay, culture-confirmed sepsis) are not reported — only process metrics.","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"warning","value":"Sex distribution of the cohort is not explicitly reported; 'mixed' is assumed based on typical NICU populations.","value_numeric":null},{"paper_doi":"10.1038/s41372-026-02710-0","tag_type":"warning","value":"The study is labeled as QI, not a randomized trial; causal attribution of outcomes to specific interventions is limited.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement (QI) initiative in a 53-bed NICU evaluated three interventions — staff education, standardized order sets for stat antibiotic doses, and a secure code medication delivery system — to reduce time from antibiotic order to administration in 1,094 neonates with suspected sepsis over 3 years.","key_result":"The proportion of infants receiving their first antibiotic dose within 60 minutes improved from 32.7% to 84.4%, and mean order-to-administration time dropped from 93.3 min to 44.7 min; gains were sustained over 2 additional years.","limitations":"Single-center study limits generalizability; no control group; clinical outcomes (e.g., mortality, culture-confirmed sepsis rates) were not reported as endpoints.","practice_takeaway":"A bundled approach — staff education, stat order sets, and a secure medication delivery system — can more than double on-time antibiotic delivery in the NICU. NICUs struggling with antibiotic delays should consider this low-tech, multidisciplinary framework."}},{"doi":"10.1080/10903127.2026.2645140","pmid":"41849737","title":"Improving Pediatric Medication Safety Through Implementation of Evidence-Based Guidelines","journal_title":"Prehospital Emergency Care","journal_issn":"1090-3127","published_at":"2026-03-18T00:00:00.000Z","url":"https://doi.org/10.1080/10903127.2026.2645140","source_score":11,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-04-22","doi":"10.1080/10903127.2026.2645140","days":"30","issn":"1090-3127","rank":"5","field":"Clinical Medicine","score":"11","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1080/10903127.2026.2645140","title":"Improving Pediatric Medication Safety Through Implementation of Evidence-Based Guidelines.","journal":"Prehospital emergency care","methods":"","results":"Correct dosing at baseline from 2020-2022 was 79% overall, with substantial variability by medication. Midazolam for pediatric seizure was the most frequently incorrectly dosed medication at baseline (65% correct). Initial improvements were observed following implementation, with median correct dosing increasing to 91% beginning in Fall 2023. Subsequent protocol changes introduced new variation, particularly related to route-specific midazolam dosing. Targeted retraining and human-centered redesign of dose presentation within the application were associated with further improvement. Sustained process improvement to 97% correct dosing for all first-dose medications was achieved by December 2025.","abstract":"$30","keywords":[],"pubmed_id":"41849737","conclusions":"","publication_date":"2026-03-18T00:00:00"},"crossref":{"DOI":"10.1080/10903127.2026.2645140","URL":"https://doi.org/10.1080/10903127.2026.2645140","ISSN":["1090-3127","1545-0066"],"link":[{"URL":"https://www.tandfonline.com/doi/pdf/10.1080/10903127.2026.2645140","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"1-8","type":"journal-article","issue":null,"score":1,"title":["Improving Pediatric Medication Safety Through Implementation of Evidence-Based Guidelines"],"author":[{"given":"Maia","family":"Dorsett","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center"}]},{"given":"Shane","family":"O’Donnell","sequence":"additional","affiliation":[{"name":"CHS Mobile Integrated Healthcare, Inc"}]},{"given":"Ward","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Case Western Reserve University"}]},{"given":"William","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Children’s Minnesota – Minneapolis Hospital"}]},{"given":"Benjamin","family":"Sensenbach","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center"}]},{"given":"Melinda","family":"Cannuli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center"}]},{"given":"Amy M.","family":"Eisenhauer","sequence":"additional","affiliation":[{"name":"Division of State EMS, New York State Department of Health"}]},{"given":"Jeremy T.","family":"Cushman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center"}]}],"funder":[{"name":"Health Resources and Services Administration Emergency Medical Services for Children State Partnership","award":["5H33MC06724"],"award-info":[{"award-number":["5H33MC06724"]}]}],"issued":{"date-parts":[[2026,3,27]]},"member":"301","prefix":"10.1080","source":"Crossref","volume":null,"created":{"date-time":"2026-03-18T20:03:09Z","timestamp":1773864189000,"date-parts":[[2026,3,18]]},"indexed":{"date-time":"2026-03-27T18:49:11Z","timestamp":1774637351590,"date-parts":[[2026,3,27]]},"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://www.tandfonline.com/doi/full/10.1080/10903127.2026.2645140"}},"subtitle":[],"assertion":[{"name":"peerreview_statement","label":"Peer Review Statement","order":1,"value":"The publishing and review policy for this title is described in its Aims & Scope."},{"URL":"http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ipec20","name":"aims_and_scope_url","label":"Aim & Scope","order":2,"value":"http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ipec20"},{"name":"received","group":{"name":"publication_history","label":"Publication History"},"label":"Received","order":0,"value":"2026-01-25"},{"name":"revised","group":{"name":"publication_history","label":"Publication History"},"label":"Revised","order":1,"value":"2026-02-11"},{"name":"accepted","group":{"name":"publication_history","label":"Publication History"},"label":"Accepted","order":2,"value":"2026-03-02"},{"name":"published","group":{"name":"publication_history","label":"Publication History"},"label":"Published","order":3,"value":"2026-03-27"}],"deposited":{"date-time":"2026-03-27T17:50:01Z","timestamp":1774633801000,"date-parts":[[2026,3,27]]},"issn-type":[{"type":"print","value":"1090-3127"},{"type":"electronic","value":"1545-0066"}],"published":{"date-parts":[[2026,3,27]]},"publisher":"Informa UK Limited","reference":[{"DOI":"10.1080/10903127.2020.1788194","key":"e_1_3_5_2_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/10903127.2022.2025962","key":"e_1_3_5_3_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.3109/10903127.2011.614043","key":"e_1_3_5_4_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/10903127.2019.1619002","key":"e_1_3_5_5_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/10903127.2020.1794085","key":"e_1_3_5_6_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1186/1471-2431-14-32","key":"e_1_3_5_7_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1136/bmjqs-2015-004411","key":"e_1_3_5_8_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":null,"key":"e_1_3_5_9_1","year":"2009","issue":null,"author":"Langley GJ","volume":null,"first-page":null,"unstructured":"Langley GJ, Moen R, Nolan KM, Nolan TW, Normal CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey-Bass; 2009.","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.1186/s12913-024-10828-0","key":"e_1_3_5_10_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1055/s-0032-1322400","key":"e_1_3_5_11_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/10903127.2022.2162648","key":"e_1_3_5_12_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.3109/10903127.2016.1139217","key":"e_1_3_5_13_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.56068/VGMR5544","key":"e_1_3_5_14_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1080/10903127.2025.2599515","key":"e_1_3_5_15_1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":null,"article-title":null,"journal-title":null,"doi-asserted-by":"publisher"}],"short-title":[],"update-policy":"https://doi.org/10.1080/tandf_crossmark_01","alternative-id":["10.1080/10903127.2026.2645140"],"content-domain":{"domain":["www.tandfonline.com"],"crossmark-restriction":true},"original-title":[],"container-title":["Prehospital Emergency Care"],"reference-count":14,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,3,27]]},"references-count":14,"short-container-title":["Prehospital Emergency Care"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1080/10903127.2026.2645140","is_oa":false,"title":"Improving Pediatric Medication Safety Through Implementation of Evidence-Based Guidelines","updated":"2026-03-20T23:48:44+00:00","published_date":"2026-03-18","best_oa_location":null}},"created_at":"2026-05-07T22:50:33.158Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"condition","value":"Pediatric Medication Dosing Errors","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"condition","value":"Pediatric Seizure","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"generic","value":"midazolam","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"modality","value":"Length-Based Weight Estimation","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"modality","value":"Volume-Based Dosing Application","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"warning","value":"Sample size (total N of patients) is not reported in the abstract or results — the sample_size tag was omitted as the number could not be verified.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"warning","value":"Study design is a QI initiative using Shewhart control charts (Model for Improvement), not a traditional experimental or observational design; level of evidence is estimated as 4.","value_numeric":null},{"paper_doi":"10.1080/10903127.2026.2645140","tag_type":"warning","value":"The paper was published in 2026 and references outcomes through December 2025; today's date is May 7, 2026, so this is a very recently published study with no external validation yet available.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement (QI) initiative in a multi-agency EMS system in upstate New York evaluated the impact of evidence-based interventions — volume-based dosing app, standardized length-based weight estimation, and case-based training — on pediatric (≤13 years) medication dosing accuracy from 2020 through December 2025.","key_result":"Baseline correct dosing was 79% overall (65% for midazolam in seizures); after iterative interventions, sustained correct dosing reached 97% for all first-dose medications by December 2025.","limitations":"Single EMS system in upstate New York limits generalizability. No control group — QI design cannot isolate the effect of any single intervention. Protocol changes mid-study introduced new variation, complicating interpretation of improvement trajectories.","practice_takeaway":"Pairing cognitive offload tools (volume-based dosing apps, length-based weight estimation) with continuous monitoring and iterative retraining can push pediatric EMS dosing accuracy from ~79% to ≥97%. Sustained gains require ongoing quality infrastructure, not just a one-time rollout."}},{"doi":"10.1200/jco-25-01815","pmid":"41740088","title":"National Quality Improvement Initiative to Increase Smoking Cessation Assistance in Commission on Cancer Programs and National Accreditation Program for Breast Centers","journal_title":"Journal of Clinical Oncology","journal_issn":"0732-183X","published_at":"2026-02-25T00:00:00.000Z","url":"https://doi.org/10.1200/jco-25-01815","source_score":28,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-04T13:23:45.768Z","updated_at":"2026-06-04T13:23:45.768Z","tags":[{"paper_doi":"10.1200/jco-25-01815","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"condition","value":"Cancer","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"condition","value":"Tobacco Use Disorder","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"modality","value":"Behavioral Counseling","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"modality","value":"Smoking Cessation Counseling","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"sample_size","value":"n=446015","value_numeric":446015},{"paper_doi":"10.1200/jco-25-01815","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"warning","value":"Current smoking rate of 11.8% is lower than general population estimates, suggesting possible under-identification of smokers in participating programs.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"warning","value":"No randomized control arm — observed improvements cannot be fully attributed to the QI intervention versus secular trends or national policy changes.","value_numeric":null},{"paper_doi":"10.1200/jco-25-01815","tag_type":"warning","value":"Sample size tag reflects total patients reported across programs; the QI intervention unit was programs (n=324), not individual patients.","value_numeric":null}],"summaries":{"what_studied":"A national quality improvement (QI) initiative ('Beyond ASK') evaluated whether accredited cancer programs could increase smoking cessation assistance for newly diagnosed cancer patients using Plan-Do-Study-Act methodology across 324 programs over 12 months (January 2023–January 2024).","key_result":"Among 446,015 newly diagnosed cancer patients, 11.8% were current smokers; the mean cessation assist rate rose from 48.0% at baseline to 67.5% at final survey (absolute increase ~19.5 percentage points). Full adoption was reported by 65.4% of programs, and all measured delivery modes increased significantly (e.g., in-office brief counseling: 33.9% → 65.8%, P = .0002).","limitations":"No control group, so secular trends cannot be ruled out. Self-reported survey data introduces risk of social desirability bias. Current smoking prevalence of 11.8% may reflect under-identification rather than true prevalence.","practice_takeaway":"Cancer programs can meaningfully scale smoking cessation assistance within one year using structured QI tools, educational webinars, and EHR guidance — making cessation support at diagnosis a practical standard of care. Clinicians should ensure every newly diagnosed cancer patient is screened for smoking and offered at least brief in-office counseling."}},{"doi":"10.1038/s41390-026-04775-1","pmid":"41535403","title":"From fragmentation to integration: the implementation of Kuwait’s nationwide pediatric intensive care units registry","journal_title":"Pediatric Research","journal_issn":"0031-3998","published_at":"2026-01-15T00:00:00.000Z","url":"https://doi.org/10.1038/s41390-026-04775-1","source_score":18,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-17","doi":"10.1038/s41390-026-04775-1","days":"7","issn":"0031-3998","rank":"9","field":"Clinical Medicine","score":"18","category":"Pediatrics","categories":["Pediatrics"],"_categories":["Pediatrics"]},"pubmed":{"doi":"10.1038/s41390-026-04775-1","title":"From fragmentation to integration: the implementation of Kuwait's nationwide pediatric intensive care units registry.","journal":"Pediatric research","methods":"","results":"During the implementation phase, 2086 of 2364 admissions were captured. Registry accuracy compared with manual admission logs was 88.2%, demonstrating feasibility and data reliability. Inter-hospital variability in clinical practices and resource utilization was identified. The registry also enabled early detection of infection trends and supported proactive staffing and equipment planning.","abstract":"$31","keywords":[],"pubmed_id":"41535403","conclusions":"Kuwait's national PICU registry is feasible, reliable, and operationally effective. It addresses critical data gaps, enhances transparency, supports evidence-based decision-making, and provides a foundation for national quality improvement and future benchmarking initiatives.","publication_date":"2026-01-15T00:00:00"},"crossref":{"DOI":"10.1038/s41390-026-04775-1","URL":"https://doi.org/10.1038/s41390-026-04775-1","ISSN":["0031-3998","1530-0447"],"link":[{"URL":"https://www.nature.com/articles/s41390-026-04775-1.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https://www.nature.com/articles/s41390-026-04775-1","content-type":"text/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https://www.nature.com/articles/s41390-026-04775-1.pdf","content-type":"application/pdf","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["From fragmentation to integration: the implementation of Kuwait’s nationwide pediatric intensive care units registry"],"author":[{"given":"Abdulrahman","family":"Aldaithan","sequence":"first","affiliation":[]},{"given":"Hashim","family":"Al-Hashimi","sequence":"additional","affiliation":[]},{"given":"Fajer","family":"Altammar","sequence":"additional","affiliation":[]},{"given":"Ahmad","family":"Almosawi","sequence":"additional","affiliation":[]},{"given":"Osama","family":"Alhindi","sequence":"additional","affiliation":[]},{"given":"Ahmed","family":"Ibrahim","sequence":"additional","affiliation":[]},{"given":"Salman","family":"Alshammari","sequence":"additional","affiliation":[]},{"given":"Abdulla","family":"Alfraij","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,1,14]]},"member":"297","prefix":"10.1038","source":"Crossref","volume":null,"created":{"date-time":"2026-01-14T23:16:25Z","timestamp":1768432585000,"date-parts":[[2026,1,14]]},"indexed":{"date-time":"2026-01-15T13:31:16Z","timestamp":1768483876232,"date-parts":[[2026,1,15]]},"license":[{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000,"date-parts":[[2026,1,14]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://creativecommons.org/licenses/by-nc-nd/4.0","start":{"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000,"date-parts":[[2026,1,14]]},"delay-in-days":0,"content-version":"vor"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://www.nature.com/articles/s41390-026-04775-1"}},"subtitle":[],"assertion":[{"name":"received","group":{"name":"ArticleHistory","label":"Article History"},"label":"Received","order":1,"value":"26 August 2025"},{"name":"revised","group":{"name":"ArticleHistory","label":"Article History"},"label":"Revised","order":2,"value":"11 December 2025"},{"name":"accepted","group":{"name":"ArticleHistory","label":"Article History"},"label":"Accepted","order":3,"value":"22 December 2025"},{"name":"first_online","group":{"name":"ArticleHistory","label":"Article History"},"label":"First Online","order":4,"value":"14 January 2026"},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"},"order":1,"value":"Patient consent was not required for this study as all patient data were de-identified and encrypted in accordance with the approval granted by the Kuwait Ministry of Health Institutional Review Board (IRB)."},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"},"order":2,"value":"The authors declare no competing interests."},{"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"},"order":3,"value":"Ethics approval for the registry was obtained from our local Institutional Review Board (IRB) in the Ministry of Health (MOH), Kuwait (Approval No. 2594/2024)."}],"deposited":{"date-time":"2026-01-14T23:16:28Z","timestamp":1768432588000,"date-parts":[[2026,1,14]]},"issn-type":[{"type":"print","value":"0031-3998"},{"type":"electronic","value":"1530-0447"}],"published":{"date-parts":[[2026,1,14]]},"publisher":"Springer Science and Business Media LLC","reference":[{"DOI":"10.1177/2333794x241285964","key":"4775_CR1","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Olatunji, G. et al. Challenges and strategies in pediatric critical care: insights from low-resource settings. Glob Pediatr Health https://doi.org/10.1177/2333794x241285964 (2024).","article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1542/peds.2013-3875","key":"4775_CR2","year":"2014","issue":null,"author":"TD Simon","volume":"133","first-page":"e1647","unstructured":"Simon, T. D. et al. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 133, e1647–e1654 (2014).","article-title":null,"journal-title":"Pediatrics","doi-asserted-by":"publisher"},{"DOI":"10.1002/hpm.2122","key":"4775_CR3","year":"2013","issue":null,"author":"G Chee","volume":"28","first-page":"85","unstructured":"Chee, G., Pielemeier, N., Lion, A. & Connor, C. Why differentiating between health system support and health system strengthening is needed. Int J. Health Plann Manag. 28, 85–94 (2013).","article-title":null,"journal-title":"Int J. Health Plann Manag.","doi-asserted-by":"publisher"},{"DOI":"10.1371/journal.pone.0183667","key":"4775_CR4","year":"2017","issue":null,"author":"DME Hoque","volume":"12","first-page":"e0183667","unstructured":"Hoque, D. M. E. et al. Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review. PLoS ONE 12, e0183667 (2017).","article-title":null,"journal-title":"PLoS ONE","doi-asserted-by":"publisher"},{"DOI":null,"key":"4775_CR5","year":"2021","issue":null,"author":"A Beane","volume":"27","first-page":"537","unstructured":"Beane, A., Salluh, J. I. F. & Haniffa, R. What intensive care registries can teach us about outcomes. Curr. Opin. Crit. Care 27, 537–543 (2021).","article-title":null,"journal-title":"Curr. Opin. Crit. Care","doi-asserted-by":null},{"DOI":"10.1097/CCM.0000000000006050","key":"4775_CR6","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Salluh, J. I. F. et al. National ICU registries as enablers of clinical research and quality improvement. Crit. Care Med. 52, 125–135 (2024).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1055/s-0039-1688477","key":"4775_CR7","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Hornik, C. P. et al. Creation of a multicenter pediatric inpatient data repository derived from electronic health records. Appl. Clin. Inf. 10, 307–315 (2019).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1007/s12630-023-02480-9","key":"4775_CR8","year":"2023","issue":null,"author":"N Roumeliotis","volume":"70","first-page":"1216","unstructured":"Roumeliotis, N. et al. Designing a national pediatric critical care database: a Delphi consensus study. Can. J. Anesthesia/J. Can. Anesthésie 70, 1216–1225 (2023).","article-title":null,"journal-title":"Can. J. Anesthesia/J. Can. Anesthésie","doi-asserted-by":"publisher"},{"DOI":"10.1186/s12911-024-02775-x","key":"4775_CR9","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Stubbs, E., Exley, J., Wittenberg, R. & Mays, N. How to establish and sustain a disease registry: insights from a qualitative study of six disease registries in the UK. BMC Med. Inf. Decis. Mak. 24, 361 (2024).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.2196/38144","key":"4775_CR10","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Li, E., Clarke, J., Ashrafian, H., Darzi, A. & Neves, A. L. The impact of electronic health record interoperability on safety and quality of care in high-income countries: systematic review. J. Med. Internet Res. 24, e38144 (2022).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1177/1740774511432555","key":"4775_CR11","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Dowling, N. M., Olson, N., Mish, T., Kaprakattu, P. & Gleason, C. A model for the design and implementation of a participant recruitment registry for clinical studies of older adults. Clin. Trials 9, 204–214 (2012).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":"10.1007/s11136-023-03393-2","key":"4775_CR12","year":"2023","issue":null,"author":"S Vanderhout","volume":"32","first-page":"2319","unstructured":"Vanderhout, S. et al. Ethical and practical considerations related to data sharing when collecting patient-reported outcomes in care-based child health research. Qual. Life Res. 32, 2319–2328 (2023).","article-title":null,"journal-title":"Qual. Life Res.","doi-asserted-by":"publisher"},{"DOI":"10.1186/s12911-022-01840-7","key":"4775_CR13","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Lazem, M. & Sheikhtaheri, A. Barriers and facilitators for disease registry systems: a mixed-method study. BMC Med. Inf. Decis. Mak. 22, 97 (2022).","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"},{"DOI":null,"key":"4775_CR14","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Information KPAFC. Statistical Reports. paci. https://stat.paci.gov.kw/englishreports/","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.4103/JPCC.JPCC_100_20","key":"4775_CR15","year":"2020","issue":null,"author":"F Shaikh","volume":"7","first-page":"260","unstructured":"Shaikh, F. Quality indicators and improvement measures for pediatric intensive care units. J. Pediatr. Crit. Care 7, 260–270 (2020).","article-title":null,"journal-title":"J. Pediatr. Crit. Care","doi-asserted-by":"publisher"},{"DOI":"10.2196/18175","key":"4775_CR16","year":"2020","issue":null,"author":"TA Wani","volume":"8","first-page":"e18175","unstructured":"Wani, T. A., Mendoza, A. & Gray, K. Hospital bring-your-own-device security challenges and solutions: systematic review of gray literature. JMIR Mhealth Uhealth 8, e18175 (2020).","article-title":null,"journal-title":"JMIR Mhealth Uhealth","doi-asserted-by":"publisher"},{"DOI":"10.1093/jamiaopen/ooz051","key":"4775_CR17","year":"2020","issue":null,"author":"X Gui","volume":"3","first-page":"53","unstructured":"Gui, X. et al. Physician champions’ perspectives and practices on electronic health records implementation: challenges and strategies. JAMIA Open 3, 53–61 (2020).","article-title":null,"journal-title":"JAMIA Open","doi-asserted-by":"publisher"},{"DOI":"10.1186/s12913-024-10867-7","key":"4775_CR18","year":"2024","issue":null,"author":"S Pettersen","volume":"24","first-page":null,"unstructured":"Pettersen, S., Eide, H. & Berg, A. The role of champions in the implementation of technology in healthcare services: a systematic mixed studies review. BMC Health Serv. Res. 24, 456 (2024).","article-title":null,"journal-title":"BMC Health Serv. Res.","doi-asserted-by":"publisher"},{"DOI":"10.1186/s13643-022-02104-1","key":"4775_CR19","year":"2022","issue":null,"author":"K Dempsey","volume":"11","first-page":null,"unstructured":"Dempsey, K. et al. Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review. Syst. Rev. 11, 237 (2022).","article-title":null,"journal-title":"Syst. Rev.","doi-asserted-by":"publisher"},{"DOI":"10.1542/peds.2020-017889","key":"4775_CR20","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Paul, R. et al. Metric development for the multicenter improving pediatric sepsis outcomes (IPSO) Collaborative. Pediatrics 147 https://doi.org/10.1542/peds.2020-017889 (2021).","article-title":null,"journal-title":null,"doi-asserted-by":"publisher"},{"DOI":"10.1055/a-2188-0736","key":"4775_CR21","year":"2024","issue":null,"author":"O Shafi","volume":"15","first-page":"55","unstructured":"Shafi, O. et al. Defining electronic health record standards for child health: a state-of-the-art review. Appl Clin. Inf. 15, 55–63 (2024).","article-title":null,"journal-title":"Appl Clin. Inf.","doi-asserted-by":"publisher"},{"DOI":"10.1038/s41390-022-02343-x","key":"4775_CR22","year":"2023","issue":null,"author":"CG Macias","volume":"93","first-page":"382","unstructured":"Macias, C. G., Remy, K. E. & Barda, A. J. Utilizing big data from electronic health records in pediatric clinical care. Pediatr. Res. 93, 382–389 (2023).","article-title":null,"journal-title":"Pediatr. Res.","doi-asserted-by":"publisher"},{"DOI":"10.1017/S1047951115001833","key":"4775_CR23","year":"2016","issue":null,"author":"M Gaies","volume":"26","first-page":"1090","unstructured":"Gaies, M. et al. Data integrity of the pediatric cardiac critical care consortium (PC4) clinical registry. Cardiol. Young. 26, 1090–1096 (2016).","article-title":null,"journal-title":"Cardiol. Young.","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.injury.2021.07.030","key":"4775_CR24","year":"2021","issue":null,"author":"CL Grant","volume":"52","first-page":"2672","unstructured":"Grant, C. L. et al. Improved documentation following the implementation of a trauma registry: a means of sustainability for trauma registries in low- and middle-income countries. Injury 52, 2672–2676 (2021).","article-title":null,"journal-title":"Injury","doi-asserted-by":"publisher"}],"short-title":[],"update-policy":"https://doi.org/10.1007/springer_crossmark_policy","alternative-id":["4775"],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"original-title":[],"container-title":["Pediatric Research"],"reference-count":24,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,1,14]]},"references-count":24,"short-container-title":["Pediatr Res"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1038/s41390-026-04775-1","is_oa":true,"title":"From fragmentation to integration: the implementation of Kuwait’s nationwide pediatric intensive care units registry","updated":"2026-01-17T01:14:18+00:00","published_date":"2026-01-14","best_oa_location":{"url":"https://www.nature.com/articles/s41390-026-04775-1.pdf","pmh_id":null,"url_for_pdf":"https://www.nature.com/articles/s41390-026-04775-1.pdf","url_for_landing_page":"https://doi.org/10.1038/s41390-026-04775-1"}}},"created_at":"2026-01-20T15:55:50.695Z","updated_at":"2026-01-20T15:55:50.695Z","tags":[{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"age_group","value":"pediatric","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"category","value":"Pediatrics","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"condition","value":"Pediatric Critical Illness","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"sample_size","value":"n=2364","value_numeric":2364},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"warning","value":"Accuracy denotes concordance between registry entries and manual admission logs; patient-level outcomes were not reported.","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"warning","value":"Design classification is approximate (registry implementation/quality improvement, not a comparative clinical study).","value_numeric":null},{"paper_doi":"10.1038/s41390-026-04775-1","tag_type":"warning","value":"Quantitative results reflect the 2023 implementation audit across seven governmental PICUs.","value_numeric":null}],"summaries":{"what_studied":"A national PICU registry was designed and rolled out across seven governmental PICUs in Kuwait, with retrospective data entry at discharge and centralized validation, to test feasibility and data accuracy during the 2023 implementation phase.","key_result":"The registry captured 2,086 of 2,364 admissions; overall concordance with manual admission logs was 88.2% (hospital range ~81.0%–96.0%). It revealed inter‑hospital variation in practices and resource use, and enabled early infection‑trend detection and proactive staffing/equipment planning.","limitations":"Findings rely on retrospectively collected, early‑phase data and on manual censuses that may be imperfect. The platform lacked full real‑time EHR integration, and long‑term funding and generalizability beyond a single national system are uncertain.","practice_takeaway":"A national PICU registry can be implemented with high data concordance and near‑term operational value. Clinicians and health leaders can use such registries to monitor infections, benchmark variation, and plan staffing and equipment at the system level."}},{"doi":"10.1016/j.jogn.2025.12.006","pmid":"41483873","title":"Implementation of a Nurse-Initiated Protocol for Prenatal Care in a Carceral Setting","journal_title":"Journal of Obstetric, Gynecologic, & Neonatal Nursing","journal_issn":"0884-2175","published_at":"2025-12-31T00:00:00.000Z","url":"https://doi.org/10.1016/j.jogn.2025.12.006","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-15T13:26:10.798Z","updated_at":"2026-07-15T13:26:10.798Z","tags":[{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"condition","value":"Opioid Withdrawal","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"condition","value":"Prenatal Care","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"modality","value":"Nurse-Initiated Protocol","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"sample_size","value":"n=50","value_numeric":50},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"warning","value":"Sample size is split across two phases (pre n=26, post n=24 patient charts) plus 44 nurses — the 'n=50' tag reflects combined patient charts, which is the primary clinical outcome group; the nurse cohort is separate. Clinicians should note these are distinct populations within the same study.","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"warning","value":"Study design is described as a quality improvement project with a before-after comparison; no randomization or control group was used, limiting causal inference.","value_numeric":null},{"paper_doi":"10.1016/j.jogn.2025.12.006","tag_type":"warning","value":"The paper was published with a date of 2025-12-31 but today's date is July 15, 2026 — this may reflect an ahead-of-print or corrected proof publication date.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement project evaluated a nurse-initiated intake protocol for prenatal care in a southeastern U.S. women's carceral facility, comparing time-to-order and time-to-implementation of prenatal care elements before (n=26) and after (n=24) protocol adoption, plus nurses' (n=44) educational intentions and perceived barriers.","key_result":"After implementation, time to order a prenatal diet and schedule the first OB appointment decreased significantly (p<.001); however, time to order prenatal labs increased significantly (p=.03). Key barriers included lack of EHR integration, care flow interruptions, and limited resources.","limitations":"Small, single-facility sample (pre n=26, post n=24) limits generalizability; no long-term maternal-fetal outcomes were measured; the uncontrolled before-after design cannot rule out confounding.","practice_takeaway":"A nurse-initiated prenatal protocol can meaningfully speed up key care steps—prenatal diet ordering and first OB scheduling—for incarcerated pregnant women. EHR integration and resource planning should be addressed before rollout to prevent delays in lab ordering."}},{"doi":"10.1001/jamasurg.2025.5179","pmid":"41296367","title":"Data and the Art of Surgical Preference Card Maintenance","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2025-11-26T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12658750/","source_score":63,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-01-16","doi":"10.1001/jamasurg.2025.5179","days":"7","issn":"2168-6254","rank":"2","field":"Clinical Medicine","score":"63","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1001/jamasurg.2025.5179","title":"Data and the Art of Surgical Preference Card Maintenance.","journal":"JAMA surgery","methods":"","results":"A total of 1298 preference cards and 432 procedures were evaluated, accounting for 3088 unique preference card-procedure combinations. The current surgical preference cards incurred a mean (SD) cost per case of unused items of $1294.41 ($2307.17), amounting to $3 716 251.11 across all cases in the study. All 3 optimization strategies reduced the cost of unused items and produced less intraoperative burden. The greatest relative reduction in the cost of unused items was seen in colorectal surgery, where cost savings of $488 774.88 reflected a 55.8% reduction.","abstract":"$32","keywords":[],"pubmed_id":"41296367","conclusions":"","publication_date":"2025-11-26T00:00:00"},"crossref":{"DOI":"10.1001/jamasurg.2025.5179","URL":"https://doi.org/10.1001/jamasurg.2025.5179","ISSN":["2168-6254"],"link":[{"URL":"https://jamanetwork.com/journals/jamasurgery/articlepdf/2841789/jamasurgery_perez_2025_oi_250079_1767031588.47263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"76","type":"journal-article","issue":"1","score":1,"title":["Data and the Art of Surgical Preference Card Maintenance"],"author":[{"given":"Sean","family":"Perez","sequence":"first","affiliation":[{"name":"Department of Surgery, University of California, San Diego"}]},{"given":"Adir","family":"Mancebo","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Patricia","family":"Lopez","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Leslie","family":"Joe","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Paul","family":"Benavidez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Diego"}]},{"given":"Zhihan","family":"Li","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Mehri","family":"Sadri","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Eduardo","family":"Spiegel-Pinzon","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Ryan","family":"Lopez","sequence":"additional","affiliation":[{"name":"Data Science Alliance, San Diego, California"}]},{"given":"Bryan","family":"Clary","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Diego"}]},{"given":"Christopher A.","family":"Longhurst","sequence":"additional","affiliation":[{"name":"Joan and Irwin Jacobs Center for Health Innovation, University of California, San Diego Health, San Diego"},{"name":"Division of Biomedical Informatics, Department of Medicine, University of California, San Diego"}]},{"given":"Kristin","family":"Mekeel","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Colorado Health, Aurora"}]},{"given":"Karandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Joan and Irwin Jacobs Center for Health Innovation, University of California, San Diego Health, San Diego"},{"name":"Division of Biomedical Informatics, Department of Medicine, University of California, San Diego"}]}],"issued":{"date-parts":[[2026,1,1]]},"member":"10","prefix":"10.1001","source":"Crossref","volume":"161","created":{"date-time":"2025-11-26T16:31:42Z","timestamp":1764174702000,"date-parts":[[2025,11,26]]},"indexed":{"date-time":"2026-01-15T13:56:10Z","timestamp":1768485370190,"date-parts":[[2026,1,15]]},"subject":[],"abstract":"$33","language":"en","relation":{},"resource":{"primary":{"URL":"https://jamanetwork.com/journals/jamasurgery/fullarticle/2841789"}},"subtitle":[],"deposited":{"date-time":"2026-01-14T16:00:47Z","timestamp":1768406447000,"date-parts":[[2026,1,14]]},"issn-type":[{"type":"print","value":"2168-6254"}],"published":{"date-parts":[[2026,1,1]]},"publisher":"American Medical Association (AMA)","reference":[{"DOI":"10.1097/SLA.0b013e3181cbcc9a","key":"soi250079r1","year":"2010","issue":"2","author":"Muñoz","volume":"251","first-page":"195","unstructured":null,"article-title":"National and surgical health care expenditures, 2005-2025.","journal-title":"Ann Surg","doi-asserted-by":"publisher"},{"DOI":"10.1001/archsurg.2010.343","key":"soi250079r2","year":"2011","issue":"2","author":"Kwakye","volume":"146","first-page":"131","unstructured":null,"article-title":"Green surgical practices for health care.","journal-title":"Arch Surg","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.pcorm.2021.100209","key":"soi250079r3","year":"2021","issue":null,"author":"Jabbal","volume":"25","first-page":null,"unstructured":null,"article-title":"Surgical waste in a colorectal surgery operating room: a five-year experience.","journal-title":"Perioper Care Oper Room Manag","doi-asserted-by":"publisher"},{"DOI":"10.1007/s00268-014-2834-2","key":"soi250079r4","year":"2015","issue":"1","author":"Wan","volume":"39","first-page":"29","unstructured":null,"article-title":"Global public health impact of recovered supplies from operating rooms: a critical analysis with national implications.","journal-title":"World J Surg","doi-asserted-by":"publisher"},{"DOI":"10.1097/QMH.0000000000000311","key":"soi250079r5","year":"2021","issue":"2","author":"Pesigan","volume":"30","first-page":"135","unstructured":null,"article-title":"Cost savings in urology operating rooms by editing surgeon preference cards.","journal-title":"Qual Manag Health Care","doi-asserted-by":"publisher"},{"DOI":"10.3171/2016.2.JNS152442","key":"soi250079r6","year":"2017","issue":"2","author":"Zygourakis","volume":"126","first-page":"620","unstructured":null,"article-title":"Operating room waste: disposable supply utilization in neurosurgical procedures.","journal-title":"J Neurosurg","doi-asserted-by":"publisher"},{"DOI":"10.1097/XCS.0000000000000972","key":"soi250079r7","year":"2024","issue":"4","author":"Filiberto","volume":"238","first-page":"404","unstructured":null,"article-title":"Operating room supply cost and value of care after implementing a sustainable quality intervention.","journal-title":"J Am Coll Surg","doi-asserted-by":"publisher"},{"DOI":"10.1093/jamia/ocaa275","key":"soi250079r8","year":"2021","issue":"6","author":"Scheinker","volume":"28","first-page":"1088","unstructured":null,"article-title":"The design and evaluation of a novel algorithm for automated preference card optimization.","journal-title":"J Am Med Inform Assoc","doi-asserted-by":"publisher"},{"DOI":"10.1097/XCS.0000000000000846","key":"soi250079r9","year":"2023","issue":"6","author":"Dixon","volume":"237","first-page":"912","unstructured":null,"article-title":"Cost saving in the operating room: scoping review of surgical scorecards.","journal-title":"J Am Coll Surg","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jmig.2017.06.018","key":"soi250079r10","year":"2017","issue":"7","author":"Harvey","volume":"24","first-page":"1116","unstructured":null,"article-title":"Physician engagement in improving operative supply chain efficiency through review of surgeon preference cards.","journal-title":"J Minim Invasive Gynecol","doi-asserted-by":"publisher"},{"DOI":"10.1007/s00464-019-07305-9","key":"soi250079r11","year":"2020","issue":"11","author":"Embick","volume":"34","first-page":"5148","unstructured":null,"article-title":"Cost containment: an experience with surgeon education and universal preference cards at two institutions.","journal-title":"Surg Endosc","doi-asserted-by":"publisher"},{"DOI":"10.1007/s10916-020-01576-9","key":"soi250079r12","year":"2020","issue":"6","author":"Geppert","volume":"44","first-page":"115","unstructured":null,"article-title":"Achieving surgical supply savings through preference card standardization.","journal-title":"J Med Syst","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.amjsurg.2017.06.024","key":"soi250079r13","year":"2018","issue":"1","author":"Simon","volume":"215","first-page":"19","unstructured":null,"article-title":"Picking apart surgical pick lists—reducing variation to decrease surgical costs.","journal-title":"Am J Surg","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jpedsurg.2015.03.009","key":"soi250079r14","year":"2015","issue":"6","author":"Skarda","volume":"50","first-page":"919","unstructured":null,"article-title":"One hospital, one appendectomy: the cost effectiveness of a standardized doctor’s preference card.","journal-title":"J Pediatr Surg","doi-asserted-by":"publisher"},{"DOI":"10.1089/109264202762252677","key":"soi250079r15","year":"2002","issue":"6","author":"Brackman","volume":"12","first-page":"411","unstructured":null,"article-title":"Bare bones laparoscopy: a randomized prospective trial of cost savings in laparoscopic cholecystectomy.","journal-title":"J Laparoendosc Adv Surg Tech A","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.aorn.2009.12.033","key":"soi250079r16","year":"2010","issue":"4","author":"Ngu","volume":"92","first-page":"425","unstructured":null,"article-title":"Improving OR efficiency in a university medical center arthroplastic surgery service.","journal-title":"AORN J","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jss.2018.11.023","key":"soi250079r17","year":"2019","issue":null,"author":"Zhao","volume":"236","first-page":"110","unstructured":null,"article-title":"Effects of a surgical receipt program on the supply costs of five general surgery procedures.","journal-title":"J Surg Res","doi-asserted-by":"publisher"},{"DOI":"10.1002/wjs.12308","key":"soi250079r18","year":"2024","issue":"9","author":"Palmisano","volume":"48","first-page":"2165","unstructured":null,"article-title":"Surgeon perspectives on preference cards and environmental stewardship.","journal-title":"World J Surg","doi-asserted-by":"publisher"},{"DOI":"10.1097/XCS.0000000000000849","key":"soi250079r19","year":"2023","issue":"6","author":"Zhao","volume":"237","first-page":"923","unstructured":null,"article-title":"Invited commentary: advocating for the penny pinchers.","journal-title":"J Am Coll Surg","doi-asserted-by":"publisher"}],"short-title":[],"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Surgery"],"published-print":{"date-parts":[[2026,1,1]]},"reference-count":19,"published-online":null,"references-count":19,"short-container-title":["JAMA Surg"],"is-referenced-by-count":1},"unpaywall":{"doi":"10.1001/jamasurg.2025.5179","is_oa":true,"title":"Data and the Art of Surgical Preference Card Maintenance","updated":"2026-01-18T01:04:10+00:00","published_date":"2025-11-26","best_oa_location":{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12658750/","pmh_id":"oai:pubmedcentral.nih.gov:12658750","url_for_pdf":null,"url_for_landing_page":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12658750/"}}},"created_at":"2025-12-08T12:24:58.509Z","updated_at":"2026-01-21T12:05:26.220Z","tags":[{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"sample_size","value":"n=3088","value_numeric":3088},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"warning","value":"Effects on patient outcomes or safety were not described.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"warning","value":"Results are modeled estimates; post-implementation outcomes were not reported.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.5179","tag_type":"warning","value":"Unit of analysis is preference card–procedure combinations, not patients.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement study in a large, tertiary multi-hospital academic system used surgical receipt data (2019-2023) from urology, colorectal, and surgical oncology to model optimal supply counts and compare three preference card optimization strategies; baseline waste was assessed from January 1 to May 31, 2024.","key_result":"Across 1298 preference cards and 432 procedures (3088 card–procedure combinations), current cards had a mean unused-item cost of $1,294.41 per case (SD $2,307.17), totaling $3,716,251.11. All three optimization strategies lowered unused-item costs and intraoperative burden; colorectal surgery achieved $488,774.88 in savings, a 55.8% relative reduction.","limitations":"Findings reflect modeled estimates against historical receipts rather than post-implementation outcomes. Conducted within a single academic health system and limited to three surgical services, which may constrain generalizability.","practice_takeaway":"Using historical receipts with regression to update preference cards—especially by stratifying existing cards at the procedure level—may reduce unused supply costs and intraoperative burden; colorectal surgery showed the greatest relative reduction (55.8%) in this analysis."}},{"doi":"10.1001/jamadermatol.2024.6443","pmid":"39937513","title":"The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products","journal_title":"JAMA Dermatology","journal_issn":"2168-6068","published_at":"2025-02-12T00:00:00.000Z","url":"https://doi.org/10.1001/jamadermatol.2024.6443","source_score":45,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2025-02-18","doi":"10.1001/jamadermatol.2024.6443","days":"30","issn":"2168-6068","rank":"5","field":"Clinical Medicine","score":"45","category":"Dermatology","categories":["Dermatology"],"_categories":["Dermatology"]},"pubmed":{"doi":"10.1001/jamadermatol.2024.6443","title":"The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products.","journal":"JAMA dermatology","methods":"","results":"","abstract":"This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.","keywords":[],"pubmed_id":"39937513","conclusions":"","publication_date":"2025-02-12T00:00:00"},"crossref":{"DOI":"10.1001/jamadermatol.2024.6443","URL":"https://doi.org/10.1001/jamadermatol.2024.6443","ISSN":["2168-6068"],"link":[{"URL":"https://jamanetwork.com/journals/jamadermatology/articlepdf/2830217/jamadermatology_barbieri_2025_ld_240036_1744811612.81047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"442","type":"journal-article","issue":"4","score":1,"title":["The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products"],"author":[{"given":"John S.","family":"Barbieri","sequence":"first","affiliation":[{"name":"Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts"},{"name":"Associate Editor and Evidence-based Practice Editor, JAMA Dermatology"}]},{"given":"Courtney B.","family":"Rubin","sequence":"additional","affiliation":[{"name":"Comprehensive Dermatology, Pasadena, California"},{"name":"Fig.1 Beauty, New York, New York"}]},{"given":"James P.","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Liverpool Hospital, Sydney, Australia"},{"name":"School of Clinical Medicine, University of New South Wales, Sydney, Australia"}]},{"given":"Michelle","family":"Wong","sequence":"additional","affiliation":[{"name":"Lab Muffin Beauty Science, Sydney, Australia"}]}],"issued":{"date-parts":[[2025,4,1]]},"member":"10","prefix":"10.1001","source":"Crossref","volume":"161","created":{"date-time":"2025-02-12T16:00:45Z","timestamp":1739376045000,"date-parts":[[2025,2,12]]},"indexed":{"date-time":"2025-08-23T05:28:23Z","timestamp":1755926903733,"date-parts":[[2025,8,23]]},"subject":[],"abstract":"This quality improvement study examines the effects of formulation on benzene levels detected in over-the-counter benzoyl peroxide products.","language":"en","relation":{},"resource":{"primary":{"URL":"https://jamanetwork.com/journals/jamadermatology/fullarticle/2830217"}},"subtitle":[],"deposited":{"date-time":"2025-04-16T15:01:03Z","timestamp":1744815663000,"date-parts":[[2025,4,16]]},"issn-type":[{"type":"print","value":"2168-6068"}],"published":{"date-parts":[[2025,4,1]]},"publisher":"American Medical Association (AMA)","reference":[{"DOI":"10.1016/j.jaad.2023.12.017","key":"dld240036r1","year":"2024","issue":"5","author":"Reynolds","volume":"90","first-page":"1006.e1","unstructured":null,"article-title":"Guidelines of care for the management of acne vulgaris.","journal-title":"J Am Acad Dermatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jid.2024.09.009","key":"dld240036r2","year":null,"issue":null,"author":"Kucera","volume":null,"first-page":null,"unstructured":null,"article-title":"Evaluation of benzene presence and formation in benzoyl peroxide drug products.","journal-title":"J Invest Dermatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jaad.2024.05.093","key":"dld240036r3","year":"2024","issue":"4","author":"Barbieri","volume":"91","first-page":"772","unstructured":null,"article-title":"Benzene in benzoyl peroxide-how worried should we be?","journal-title":"J Am Acad Dermatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jaad.2024.06.050","key":"dld240036r4","year":"2024","issue":"4","author":"Sadr","volume":"91","first-page":"763","unstructured":null,"article-title":"No evidence for an association between benzoyl peroxide use and increased blood benzene levels in the National Health and Nutrition Examination Survey.","journal-title":"J Am Acad Dermatol","doi-asserted-by":"publisher"},{"DOI":"10.1016/j.jaad.2024.07.011","key":"dld240036r5","year":null,"issue":null,"author":"Garate","volume":null,"first-page":null,"unstructured":null,"article-title":"Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study.","journal-title":"J Am Acad Dermatol","doi-asserted-by":"publisher"},{"DOI":null,"key":"dld240036r6","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Bader? K. Benzene in Benzoyl Peroxide at Room Temperature: What Comes Next? Dermatology Times. October 10, 2024. Accessed October 14, 2024. https://www.dermatologytimes.com/view/benzene-in-benzoyl-peroxide-at-room-temperature-what-comes-next-","article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Dermatology"],"published-print":{"date-parts":[[2025,4,1]]},"reference-count":6,"published-online":null,"references-count":6,"short-container-title":["JAMA Dermatol"],"is-referenced-by-count":4},"unpaywall":{"doi":"10.1001/jamadermatol.2024.6443","is_oa":false,"title":"The Role of Formulation in Benzene Formation in Benzoyl Peroxide Products","updated":"2025-08-04T14:10:34+00:00","published_date":"2025-02-12","best_oa_location":null}},"created_at":"2025-09-19T22:06:30.810Z","updated_at":"2025-09-19T22:59:21.441Z","tags":[{"paper_doi":"10.1001/jamadermatol.2024.6443","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.6443","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.6443","tag_type":"warning","value":"Only a brief abstract statement was provided; no methods, sample size, or results were available to summarize.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.6443","tag_type":"warning","value":"Study design label may not map cleanly to standard evidence hierarchies.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.6443","tag_type":"warning","value":"Without full text, specific formulations tested and quantitative benzene levels are unknown.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement study evaluated whether product formulation affects benzene levels detected in over‑the‑counter benzoyl peroxide products."}}],"initialOffset":20,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"study_design","value":"Quality Improvement Study"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Study Designs","href":"/hub/tag/study_design"},{"name":"Quality Improvement Study"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"study_design","hub_tag_value":"Quality Improvement Study"}}}]]

Papers