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In adolescents and young adults, suicide is the second leading cause of death [1]. Suicide is a growing public health concern which requires ongoing effort to identify patients with suicidal ideation early to provide necessary resources and interventions to prevent negative outcomes.Financial support This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.Author contributions Michelle L Pickett: Conceptualization, methodology, formal analysis, writing-original draft, visualization; Callie Krentz: Data curation, formal analysis, writing-original draft; Mark Nimmer: Data curation, formal analysis, writing-review and editing; Ashley Servi: conceptualization, writing-review and editing; Anna Schmitz: Methodology, writing-review and editing; Amy L Drendel: Conceptualization, writing-review and editing, supervision.Presentation This was presented as a poster presentation at the Pediatric Academic Societies annual meeting in Baltimore, Maryland in April 2019.Declaration of Competing Interest None. Screened (N = 1577) Not screened (N = 484) p-Value Gender, female 851 (54.0) 255 (52.7) 0.622 Age 0.279 11–14 years old 862 (54.7) 251 (51.9) 15–18 years old 715 (45.3) 233 (48.1) Chief complaint 0.023 Non-psychiatric 1494 (94.7) 445 (91.9) Psychiatrica 83 (5.3) 39 (8.1) Triage level <0.001 1 4 (0.25) 14 (2.9) 2 193 (12.2) 121 (25.0) 3 781 (49.5) 208 (43.0) 4 516 (32.7) 108 (22.3) 5 83 (5.3) 21 (4.3) Unknown 0 (0.0) 12 (2.5) Disposition <0.001 Discharged 1373 (87.1) 332 (68.6) Admitted 178 (11.3) 114 (23.6) AMA/Eloped/LWBSb 5 (0.32) 15 (3.1) Transferred (psychiatric) 17 (1.1) 18 (3.7) Transferred (non-psychiatric) 4 (0.26) 3 (0.61) Unknown 0 (0.0) 2 (0.40) Table 2 Comparison of screened and not screened patient encounters during the post-implementation period, N (%).

Objective In patients treated for DKA, decrease the rate of visits experiencing one or more BG < 80 mg/dl by 10% within 24 months. Research Design and Methods Plan‐do‐study‐act cycles tested interventions linked to key drivers including: standardized DKA guidelines incorporating a two‐bag fluid system, efficient ordering process, and care team education. Inclusion criterion: treatment for DKA with a bicarbonate value (HCO3) <15 mEq/L. Primary outcome: the percent of patient visits experiencing a BG < 80 mg/dl while undergoing treatment for DKA. Process measures included: order panel and order set utilization rates. Balancing measures included: emergency department and hospital lengths of stay, time to acidosis resolution (time to HCO3 ≥ 17 mEq/L), and admission rates. Outcomes were analyzed using statistical process control charts. Results From January 2017 through May 2021, our institution treated 288 different patients during 557 visits for suspected DKA. Following our interventions, the overall percent of patient visits for DKA with a BG < 80 mg/dl improved from 32% to 5%. The team did see small improvements in emergency department and hospital lengths of stay; otherwise, there was no significant change in our balancing measures. Conclusions Use of quality improvement methodology and standardized DKA management resulted in a significant reduction of BG < 80 mg/dl in patients treated for DKA.

Children increasingly are being seen in the emergency department for a concussion, or mild traumatic brain injury (mTBI). A key aim of the ED visit is to provide discharge advice that can help parents to identify an evolving neurosurgical crisis, facilitate recovery, and prevent reinjury. The present study examined parents’ knowledge of symptoms and recall of discharge instructions after their adolescent’s mTBI and the effect of supplementing written discharge instructions with verbal instruction and reinforcement. We performed a nested observational study of parents/caregivers of patients who participated in a larger mTBI study. After their adolescent’s mTBI, parents were given verbal and standardized written instructions. The ED discharge process was observed using a structured checklist, and parents were surveyed 3 days after discharge on knowledge and recall of discharge instructions. Ninety-three parents completed the postsurvey. Nearly 1 in 5 parents were confused about when to return to the emergency department after evaluation for head injury. Up to 1 in 4 parents could not recall specific discharge advice related to concussion. Parents who received verbal reinforcement of written discharge instructions were more likely to recall them. Emergency nurses and clinicians should strive to utilize both verbal and written discharge instructions with families to help increase understanding.Image 1

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