{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:12:46Z","timestamp":1774620766405,"version":"3.50.1"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We implemented 4 prospective QI interventions at our tertiary children\u2019s hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015\u2013October 17, 2016) and implementation (October 18, 2016\u2013April 2019).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%\u201311%; 95% confidence interval 70\u201392) and 33% relative reduction in sedations per patient (centerline shift 1.8\u20131.2; 95% confidence interval 21\u201346). Empirical vancomycin use did not change (centerline 20%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-0118","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T09:53:10Z","timestamp":1610013190000},"source":"Crossref","is-referenced-by-count":14,"title":["Improving Care and Outcomes for Pediatric Musculoskeletal Infections"],"prefix":"10.1542","volume":"147","author":[{"given":"Gabrielle Z.","family":"Hester","sequence":"first","affiliation":[{"name":"Departments of Quality,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda J.","family":"Nickel","sequence":"additional","affiliation":[{"name":"Research Institute, Children\u2019s Minnesota, Minneapolis, Minnesota; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Watson","sequence":"additional","affiliation":[{"name":"Research Institute, Children\u2019s Minnesota, Minneapolis, Minnesota; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Swanson","sequence":"additional","affiliation":[{"name":"Hospital Medicine,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer C.","family":"Laine","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, and"},{"name":"Gillette Children\u2019s Specialty Healthcare, St Paul, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly R.","family":"Bergmann","sequence":"additional","affiliation":[{"name":"Emergency Medicine and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"issue":"1","key":"2021121023345263100_B1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1471-2431-8-45","article-title":"Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study","volume":"8","author":"Riise","year":"2008","journal-title":"BMC Pediatr"},{"issue":"2","key":"2021121023345263100_B2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s11420-018-9644-2","article-title":"Pediatric septic arthritis and osteomyelitis in the USA: a national KID database analysis","volume":"15","author":"Safdieh","year":"2019","journal-title":"HSS J"},{"issue":"4","key":"2021121023345263100_B3","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1056\/NEJMra1213956","article-title":"Acute osteomyelitis in children","volume":"370","author":"Peltola","year":"2014","journal-title":"N Engl J Med"},{"issue":"4","key":"2021121023345263100_B4","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/ACO.0b013e32833bb524","article-title":"Anaesthesia or sedation for MRI in children","volume":"23","author":"Schulte-Uentrop","year":"2010","journal-title":"Curr Opin Anaesthesiol"},{"issue":"4","key":"2021121023345263100_B5","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/ACO.0b013e32832dba6e","article-title":"Risk and safety of pediatric sedation\/anesthesia for procedures outside the operating room","volume":"22","author":"Cravero","year":"2009","journal-title":"Curr Opin Anaesthesiol"},{"issue":"2","key":"2021121023345263100_B6","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1542\/peds.2008-0596","article-title":"Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children","volume":"123","author":"Zaoutis","year":"2009","journal-title":"Pediatrics"},{"issue":"2","key":"2021121023345263100_B7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1001\/jamapediatrics.2014.2822","article-title":"Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children","volume":"169","author":"Keren","year":"2015","journal-title":"JAMA Pediatr"},{"issue":"1","key":"2021121023345263100_B8","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00006454-198201000-00004","article-title":"Oral antibiotic therapy for bone and joint infections","volume":"1","author":"Prober","year":"1982","journal-title":"Pediatr Infect Dis"},{"issue":"5","key":"2021121023345263100_B9","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/BPO.0b013e31817bb816","article-title":"Changing trends in acute osteomyelitis in children: impact of methicillin-resistant Staphylococcus aureus infections","volume":"28","author":"Saavedra-Lozano","year":"2008","journal-title":"J Pediatr Orthop"},{"issue":"10","key":"2021121023345263100_B10","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1016\/j.ajem.2015.07.011","article-title":"Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era","volume":"33","author":"Ratnayake","year":"2015","journal-title":"Am J Emerg Med"},{"issue":"14","key":"2021121023345263100_B11","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa043252","article-title":"Methicillin-resistant Staphylococcus aureus disease in three communities","volume":"352","author":"Fridkin","year":"2005","journal-title":"N Engl J Med"},{"issue":"11","key":"2021121023345263100_B12","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.3201\/eid1411.080337","article-title":"Growth and geographic variation in hospitalizations with resistant infections, United States, 2000-2005","volume":"14","author":"Zilberberg","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"8","key":"2021121023345263100_B13","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/01.inf.0000078901.26909.cf","article-title":"Culture-negative osteomyelitis","volume":"22","author":"Floyed","year":"2003","journal-title":"Pediatr Infect Dis J"},{"issue":"5","key":"2021121023345263100_B14","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1542\/hpeds.2017-0079","article-title":"Comparison of empiric antibiotics for acute osteomyelitis in children","volume":"8","author":"McBride","year":"2018","journal-title":"Hosp Pediatr"},{"issue":"6","key":"2021121023345263100_B15","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1177\/0897190014546114","article-title":"Vancomycin nephrotoxicity: a review","volume":"27","author":"Mergenhagen","year":"2014","journal-title":"J Pharm Pract"},{"issue":"6","key":"2021121023345263100_B16","doi-asserted-by":"crossref","first-page":"895","DOI":"10.3201\/eid1106.050156","article-title":"Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in rural communities, western United States","volume":"11","author":"Stevenson","year":"2005","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"2021121023345263100_B17","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/INF.0b013e31824e10d7","article-title":"Defining risk factors for red man syndrome in children and adults","volume":"31","author":"Myers","year":"2012","journal-title":"Pediatr Infect Dis J"},{"issue":"6","key":"2021121023345263100_B18","doi-asserted-by":"crossref","first-page":"e354","DOI":"10.1097\/BPO.0000000000001187","article-title":"Improved diagnosis and treatment of bone and joint infections using an evidence-based treatment guideline","volume":"38","author":"Quick","year":"2018","journal-title":"J Pediatr Orthop"},{"issue":"22","key":"2021121023345263100_B19","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.2106\/JBJS.O.00403","article-title":"Improved magnetic resonance imaging utilization for children with musculoskeletal infection","volume":"97","author":"Mueller","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"8","key":"2021121023345263100_B20","doi-asserted-by":"crossref","first-page":"686","DOI":"10.2106\/JBJS.L.00037","article-title":"The impact of evidence-based clinical practice guidelines applied by a multidisciplinary team for the care of children with osteomyelitis","volume":"95","author":"Copley","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"2021121023345263100_B21","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1093\/jpids\/pix014","article-title":"Clinical care guideline for improving pediatric acute musculoskeletal infection outcomes","volume":"6","author":"Spruiell","year":"2017","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"1","key":"2021121023345263100_B22","doi-asserted-by":"crossref","first-page":"e20180387","DOI":"10.1542\/peds.2018-0387","article-title":"Use of a clinical care algorithm to improve care for children with hematogenous osteomyelitis","volume":"143","author":"Robinette","year":"2019","journal-title":"Pediatrics"},{"issue":"5","key":"2021121023345263100_B23","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1001\/jamapediatrics.2019.0067","article-title":"Do we really need scholarly quality improvement?","volume":"173","author":"Ralston","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2021121023345263100_B24","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009","edition":"2nd ed"},{"key":"2021121023345263100_B25","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"key":"2021121023345263100_B26","article-title":"CPI inflation calculator","author":"US Bureau of Labor Statistics"},{"key":"2021121023345263100_B27","first-page":"103","volume-title":"Introduction to Statistical Quality Control","author":"Montgomery","year":"2009","edition":"6th ed"},{"issue":"6","key":"2021121023345263100_B28","doi-asserted-by":"crossref","first-page":"994","DOI":"10.2106\/00004623-200306000-00002","article-title":"A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip","volume":"85","author":"Kocher","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"2021121023345263100_B29","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1542\/hpeds.2019-0152","article-title":"Feasible strategies for sustaining guideline adherence: cross-sectional analysis of a national collaborative","volume":"9","author":"Kaiser","year":"2019","journal-title":"Hosp Pediatr"},{"issue":"8","key":"2021121023345263100_B30","first-page":"CD010669","article-title":"Tools developed and disseminated by guideline producers to promote the uptake of their guidelines","author":"Flodgren","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2021121023345263100_B31","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1097\/pq9.0000000000000153","article-title":"A framework for maintenance and scaling of an evidence-based guideline program","volume":"4","author":"Seneski","year":"2019","journal-title":"Pediatr Qual Saf"},{"issue":"4","key":"2021121023345263100_B32","doi-asserted-by":"crossref","first-page":"e20180803","DOI":"10.1542\/peds.2018-0803","article-title":"Improving the safety of teratogen prescribing practices in a pediatric rheumatology clinic","volume":"143","author":"Cooper","year":"2019","journal-title":"Pediatrics"},{"issue":"3","key":"2021121023345263100_B33","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jor.2017.06.004","article-title":"Nationwide survey of pediatric septic arthritis in the United States","volume":"14","author":"Okubo","year":"2017","journal-title":"J Orthop"},{"key":"2021121023345263100_B34","doi-asserted-by":"crossref","first-page":"103.e3","DOI":"10.1016\/j.jpeds.2019.06.064","article-title":"Complications of serious pediatric conditions in the emergency department: definitions, prevalence, and resource utilization","volume":"214","author":"Michelson","year":"2019","journal-title":"J Pediatr"},{"key":"2021121023345263100_B35","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13012-014-0092-1","article-title":"Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol","volume":"9","author":"Gould","year":"2014","journal-title":"Implement Sci"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-0118\/1082764\/peds_20200118.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2020-0118\/1082764\/peds_20200118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T08:02:45Z","timestamp":1639209765000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/147\/2\/e20200118\/36225\/Improving-Care-and-Outcomes-for-Pediatric"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,1]]},"references-count":35,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,1]]},"published-print":{"date-parts":[[2021,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2020-0118","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,1]]},"article-number":"e20200118"}}