Pediatric mediastinal mass algorithm: A quality improvement initiative to reduce time from presentation to biopsy

• DOI: 10.1111/pan.14210
• Publication Date: 2021-05-18T09:05:27Z
• Authors: Jamie M. Fleming; Savannah Ross; Lindsey M. Hoffman; Rebecca Coughlin; Timothy M. Crombl...; David A. Mong; Joanne Hilden; Kelly Maloney; Gee Mei Tan
• Keywords: PDCA; Presentation (obstetrics)

Abstract Background Mediastinal masses in children may present with compression of the great vessels and airway. An interdisciplinary plan for rapid diagnosis, acute management, treatment prevents devastating outcomes optimizes care. Emergency pretreatment steroids or radiation is more likely to be administered when care variable, which delay complicate diagnosis treatment. Strategies standardize expedite improve patient safety long‐term outcomes. Aims The aim this quality improvement project was decrease time from presentation diagnostic biopsy an anterior mediastinal mass by 50% over 3 years within a tertiary healthcare system. Methods This involved single center data collected analyzed retrospectively prospectively 71 patients presenting between February 2008 January 2018. Model Improvement utilized design development driver diagram smart aim. algorithm implemented facilitate communication teams initial masses. underwent multiple Plan‐Do‐Study‐Act (PDSA) cycles. Data were before after implementation each PDSA cycle. primary outcome measure included biopsy, monitored statistical process control chart. Several measures evaluated Student's t ‐tests including administration emergency pretreatment. Results Nineteen preintervention 52 postintervention analysis. Time significantly decreased 48 h at baseline 24 postimplementation. Although not statistically significant, 26.3% 6.7% Conclusion Implementation management coordinating among multidisciplinary reduced result use emergent