Background Caring for pediatric lacerations in the Emergency Department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. Local Problem The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention. Methods We conducted a prospective, single center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying two key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days post encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and side effects of EMLA. Results We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. PDSA cycles used educational interventions, direct provider feedback about non-compliance and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, No adverse events but an increase in LOS of patients who received EMLA compared to those who did not (1.79 +/- 0.66 VS 1.41 +/- 0.83 hours, p<0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications. Conclusion With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.

中文翻译：

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急诊科小儿撕裂伤局部麻醉：质量改进项目

背景 在急诊科 (ED) 护理小儿裂伤通常会因冲洗和缝合而疼痛。为了改善这种痛苦的体验，我们的目标是在符合条件的儿科撕裂伤中增加局部麻醉剂、局部麻醉剂共晶混合物 (EMLA) 的使用，目标是可实现、可持续和可衡量的 60%。局部问题 在我们的 ED 中，对符合条件的撕裂伤应用局部麻醉剂的基线率为 23%。我们的目标是在实施干预后的 3 个月内，将局部麻醉剂在符合条件的儿科撕裂伤上的使用增加到 60% 的可衡量目标。方法 我们从 2019 年 11 月至 2020 年 7 月进行了一项前瞻性、单中心、间断时间序列的 ED 质量改进项目。一个由医生和护士组成的多学科团队进行了因果分析，确定了两个关键驱动因素：早期放置 EMLA 和医生认同我们在此基础上建立了我们的计划、行动、研究和行动 (PDSA) 周期。我们收集了有关接受 EMLA 的合格患者数量的数据，以及在遭遇后 2 天内通过电话获得的患者和医生反馈。平衡措施包括 ED 住院时间 (LOS)、患者和医生对 EMLA 的满意度以及 EMLA 的副作用。结果 我们需要 3 个 PDSA 循环才能在 3 个月内达到 60% 的目标，该目标也维持了 5 个月。PDSA 循环使用教育干预、直接提供者关于不合规性的反馈以及通过电话获得的患者满意度结果。平衡措施受到的影响最小：75% 的患者满意度良好，与未接受 EMLA 的患者相比，接受 EMLA 的患者没有不良事件，但 LOS 增加（1.79 +/- 0.66 VS 1.41 +/- 0.83 小时，p<0.001）。医生不满意的主要原因是 LOS 增加以及对程序镇静或鼻内药物的偏好。结论 通过一些简单的干预，我们实现并维持了将 EMLA 应用于 60% 符合条件的儿科撕裂伤的目标。