Abstract：
BACKGROUND: Comprehensive guidelines for the management of iron deficiency anemia (IDA) in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize the evaluation and management of these patients through the development and implementation of an evidence-based algorithm using quality improvement methodology.
METHODS: Baseline data of the target population identified variability across four key measures of clinical management: therapy choice and administration, laboratory evaluation, hematology service consultation, and patient disposition. Literature review and consensus from pediatric hematology and gynecology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From December 2022 to July 2023, we aimed to achieve a 25% relative increase in patients to receive optimal management per the algorithm, while using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider documentation and balancing measures, such as ED length of stay, were assessed concurrently.
RESULTS: Forty-nine patients were evaluated during four PDSA cycles. Improvement of ≥40% above baseline regarding recommended therapy administration was achieved across four PDSA cycles. Adherence to recommended therapy choice improved from 57% (baseline) to 100%, minimal laboratory evaluation from 14% to 83%, hematology consultation from 36% to 100%, and appropriate disposition from 71% to 100%. ED length of stay remained stable.
CONCLUSIONS: Implementation of a standardized algorithm for management of IDA secondary to HMB in adolescents in the ED increased adherence to evidence-based patient care.
METHODS: Baseline data of the target population identified variability across four key measures of clinical management: therapy choice and administration, laboratory evaluation, hematology service consultation, and patient disposition. Literature review and consensus from pediatric hematology and gynecology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From December 2022 to July 2023, we aimed to achieve a 25% relative increase in patients to receive optimal management per the algorithm, while using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider documentation and balancing measures, such as ED length of stay, were assessed concurrently.
RESULTS: Forty-nine patients were evaluated during four PDSA cycles. Improvement of ≥40% above baseline regarding recommended therapy administration was achieved across four PDSA cycles. Adherence to recommended therapy choice improved from 57% (baseline) to 100%, minimal laboratory evaluation from 14% to 83%, hematology consultation from 36% to 100%, and appropriate disposition from 71% to 100%. ED length of stay remained stable.
CONCLUSIONS: Implementation of a standardized algorithm for management of IDA secondary to HMB in adolescents in the ED increased adherence to evidence-based patient care.
摘要：
背景：缺乏针对急诊（ED）出现月经大出血（HMB）的青少年缺铁性贫血（IDA）的管理的综合指南，导致护理的可变性。我们旨在通过使用质量改进方法开发和实施基于证据的算法来标准化这些患者的评估和管理。
方法：目标人群的基线数据确定了临床管理的四个关键指标之间的差异：治疗选择和管理，实验室评估,血液学服务咨询，和病人的性格。儿科血液学和妇科提供者的文献综述和共识告知了在迭代多学科过程中完善的算法草案。从2022年12月到2023年7月，我们的目标是使患者相对增加25％，以根据算法获得最佳管理。同时使用序贯计划-做-研究-行动（PDSA）周期。专注于提供商文档和平衡措施的过程措施，如ED停留时间，同时评估。
结果：在四个PDSA周期中评估了49名患者。在四个PDSA周期中，推荐治疗给药的基线改善≥40％。对推荐治疗选择的依从性从57%（基线）提高到100%，最低实验室评估从14%到83%，血液学咨询从36%到100%，以及从71%到100%的适当配置。ED停留时间保持稳定。
结论：在ED青少年中实施HMB继发IDA管理的标准化算法提高了对循证患者护理的依从性。
方法：目标人群的基线数据确定了临床管理的四个关键指标之间的差异：治疗选择和管理，实验室评估,血液学服务咨询，和病人的性格。儿科血液学和妇科提供者的文献综述和共识告知了在迭代多学科过程中完善的算法草案。从2022年12月到2023年7月，我们的目标是使患者相对增加25％，以根据算法获得最佳管理。同时使用序贯计划-做-研究-行动（PDSA）周期。专注于提供商文档和平衡措施的过程措施，如ED停留时间，同时评估。
结果：在四个PDSA周期中评估了49名患者。在四个PDSA周期中，推荐治疗给药的基线改善≥40％。对推荐治疗选择的依从性从57%（基线）提高到100%，最低实验室评估从14%到83%，血液学咨询从36%到100%，以及从71%到100%的适当配置。ED停留时间保持稳定。
结论：在ED青少年中实施HMB继发IDA管理的标准化算法提高了对循证患者护理的依从性。
