{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:50:38Z","timestamp":1791219038183,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T00:00:00Z","timestamp":1672272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Guidelines for young children with nutritional iron deficiency anemia (IDA) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize management of these patients through the development and implementation of an evidence\u2010based algorithm using quality improvement methodology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Baseline data of the target population (<jats:italic>n<\/jats:italic>\u00a0=\u00a042; 60% male; median age 22.5 months, median hemoglobin 5.3\u00a0g\/dl) identified variability across four key measures of clinical management: laboratory evaluation, therapy choice, therapy administration, and patient disposition. Literature review and consensus from pediatric hematology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From September 2020 to June 2021, we aimed to increase IDA management per the algorithm by \u226520% relative to baseline for the four key outcome measures using sequential Plan\u2010Do\u2010Study\u2010Act (PDSA) cycles. Process measures focusing on provider communication\/documentation and balancing measures involving efficiency and therapy\u2010related adverse events were assessed concurrently.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five patients were evaluated among four PDSA cycles and shared similar characteristics as the baseline population. Improvements of \u226520% above baseline adherence levels or 100% adherence were achieved for all outcome measure across four PDSA cycles. Adherence to recommended laboratory evaluation improved from 43 (baseline) to 71%, therapy choice from 78 to 100%, therapy administration from 50 to 83%, and disposition from 85 to 100%. ED length of stay remained stable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Implementation of a standardized algorithm for young children with nutritional IDA in the ED increased adherence to evidence\u2010based patient care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30181","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T12:24:03Z","timestamp":1672316643000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Management of nutritional iron deficiency anemia for young children in the emergency department"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8767-0215","authenticated-orcid":false,"given":"Matthew T.","family":"McEvoy","sequence":"first","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5938-7495","authenticated-orcid":false,"given":"Austin J.","family":"Stuckert","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6464-1056","authenticated-orcid":false,"given":"Maria I.","family":"Castellanos","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"},{"name":"UCSF Benioff Children's Hospitals Department of Pediatrics  San Francisco\/Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3687-3412","authenticated-orcid":false,"given":"Megan M.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-669X","authenticated-orcid":false,"given":"Thomas","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"},{"name":"St.\u00a0Louis\u00a0Children's Hospital, Department of Pediatrics, Division of Hematology\/Oncology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3789-1121","authenticated-orcid":false,"given":"Zachary","family":"Prudowsky","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6294-0549","authenticated-orcid":false,"given":"Xavier","family":"Rios","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0413-5191","authenticated-orcid":false,"given":"Gladstone","family":"Airewele","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9492-8675","authenticated-orcid":false,"given":"M. Fatih","family":"Okcu","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacquelyn M.","family":"Powers","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Section of Hematology\/Oncology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1401038"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8060330"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014\u20103979"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0022\u20103476(99)70177\u20100"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.05.015"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010\u20102576"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0502"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/08830738040190070901"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7513782"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30014"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25433"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V126.23.4454.4454"},{"key":"e_1_2_8_14_1","unstructured":"Government of British Columbia. Iron Deficiency \u2010 Diagnosis and Management. BCGuidelines.ca. British Columbia Guidelines & Protocols Advisory Committee. Published April 17 2019. Accessed April 8 2022. 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