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INTRODUCTION: The University of Florida Equal Access Clinic Network (EACN) is the largest student-run free clinic (SRFC) network in Florida. This student-driven, continuous quality improvement (CQI) project is intended to decrease total patient visit length at Eastside clinic, one of EACN's primary care sites. The original median visit length of 126.25 minutes represented a significant time burden for patients, especially those with limited transportation or inflexible schedules. METHODS: Over six months, four Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA cycle 1 increased personnel and space for taking vitals. PDSA cycle 2 reduced redundancy in the intake process. PDSA cycle 3 triaged patients to match patient complexity with student experience level. PDSA cycle 4 introduced "nudge" interventions to reinforce clinic flow. Total patient visit length and time spent at each step of clinic flow were recorded anonymously for each patient visit. The median visit length per week was tracked on a run chart. RESULTS: From PDSA cycle 1 through PDSA cycle 4, the median visit length decreased from 126 minutes to 114 minutes. This shift was primarily driven by a decrease in the length of patient intake from a median of 19 minutes to 9 minutes. The run chart did not show clear trends until PDSA cycle 4, which demonstrated a strong downward trend. CONCLUSION: This study demonstrated the ability of a student-driven CQI model to decrease patient visit length in an SRFC setting. Similar models could be used to address this and other contributors to patient experience across SRFCs nationwide.
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OBJECTIVE: This review summarizes the approaches to pediatric sialorrhea management from least-to-most invasive: non-pharmacological management, anticholinergic medications, botulinum neurotoxin, non-invasive surgery, and invasive surgical intervention. REVIEW METHODS: An electronic literature review identified English-language articles on sialorrhea management in pediatric patients. Publications between 1982 and 2022 were used, with a focus on articles published from 2012 to 2022. Additional augmentation of pharmacologic information was obtained from the latest editions of medical textbooks supplemented with official package inserts of investigated medications. CONCLUSIONS: Sialorrhea is abnormal in patients greater than four years of age. Severe cases warrant intervention to improve patient quality of life and reduce caregiver burden. Management starts with conservative approaches. Viable candidates begin with non-pharmacological management options. Anticholinergic medications can decrease saliva production, but adverse side effects may outweigh benefits. Botulinum neurotoxin injection of the salivary glands decreases salivary flow rate; however, relief is transient and thus multiple treatments are required. Non-invasive sclerotherapy is an emerging treatment option showing promising results for sialorrhea. In contrast, surgical intervention is reserved as a last-resort treatment for patients with severe symptoms, due to its higher risk for adverse consequences. IMPLICATIONS FOR PRACTICE: Physicians should be familiar with the different pediatric sialorrhea management options, including advantages and disadvantages, to adequately facilitate shared decision making with caretakers of pediatric patients who require treatment.
Asunto(s)
Antagonistas Colinérgicos , Sialorrea , Humanos , Sialorrea/terapia , Sialorrea/etiología , Niño , Antagonistas Colinérgicos/uso terapéutico , Preescolar , Calidad de Vida , Glándulas Salivales , Femenino , Adolescente , Toxinas Botulínicas/uso terapéutico , Toxinas Botulínicas/administración & dosificación , MasculinoRESUMEN
OBJECTIVE: Determine the efficacy of a team-based approach to reduce tracheostomy-related skin breakdown by creating a standardized intraoperative dressing and nursing wound care protocol. METHODS: Prospective data collection of pediatric tracheostomy outcomes before and after interventions consisting of intraoperative wound dressing and standardized nursing wound care bundles. RESULTS: Before intervention, the incidence of skin breakdown within the first-week post-tracheostomy was 52% (13/25). Among patients who received an intraoperative wound dressing and nursing wound care bundles, the incidence of skin breakdown was reduced to 6.1% (3/49). CONCLUSION: The adoption of intraoperative wound dressings and nursing wound care bundles has nearly eliminated the incidence of skin breakdown in the first week post-tracheostomy among patients 0-12 years of age.