BACKGROUND: Mediastinal masses in children may present with compression of the great vessels and airway. An interdisciplinary plan for rapid diagnosis, acute management, and treatment prevents devastating outcomes and optimizes care. Emergency pre-treatment with steroids or radiation is more likely to be administered when care is variable, which may delay and complicate diagnosis and treatment. Strategies to standardize care and expedite diagnosis may improve acute patient safety and long-term outcomes. AIMS: The aim of this quality improvement project was to decrease time from presentation to diagnostic biopsy for children with an anterior mediastinal mass by 50% over 3 years within a tertiary healthcare system. METHODS: This quality improvement project involved a single center with data collected and analyzed retrospectively and prospectively for 71 patients presenting with anterior mediastinal mass between February 2008 and January 2018. The Model for Improvement was utilized for project design and development of a driver diagram and smart aim1 . An algorithm was implemented to facilitate communication between teams and standardize initial care of patients with mediastinal masses. The algorithm underwent multiple Plan-Do-Study-Act (PDSA) cycles. Data was collected before and after algorithm implementation and between each PDSA cycle. The primary outcome measure included time from presentation to biopsy, which was monitored with a statistical process control chart. Several process measures were evaluated with Student's t-tests including administration of emergency pre-treatment. RESULTS: Nineteen patients pre-intervention and 52 patients post-intervention were included in the analysis. Time from presentation to biopsy significantly decreased from 48 hours at baseline to 24 hours post-implementation. Although not statistically significant, emergency pre-treatment decreased from a baseline of 26.3% to 6.7% post-implementation. CONCLUSION: Implementation of a diagnostic and management algorithm coordinating care among multi-disciplinary teams significantly reduced time to biopsy for children presenting with mediastinal mass and may result in decreased use of emergent pre-treatment. This article is protected by copyright. All rights reserved.
BACKGROUND: Mediastinal masses in children may present with compression of the great vessels and airway. An interdisciplinary plan for rapid diagnosis, acute management, and treatment prevents devastating outcomes and optimizes care. Emergency pre-treatment with steroids or radiation is more likely to be administered when care is variable, which may delay and complicate diagnosis and treatment. Strategies to standardize care and expedite diagnosis may improve acute patient safety and long-term outcomes. AIMS: The aim of this quality improvement project was to decrease time from presentation to diagnostic biopsy for children with an anterior mediastinal mass by 50% over 3 years within a tertiary healthcare system. METHODS: This quality improvement project involved a single center with data collected and analyzed retrospectively and prospectively for 71 patients presenting with anterior mediastinal mass between February 2008 and January 2018. The Model for Improvement was utilized for project design and development of a driver diagram and smart aim1 . An algorithm was implemented to facilitate communication between teams and standardize initial care of patients with mediastinal masses. The algorithm underwent multiple Plan-Do-Study-Act (PDSA) cycles. Data was collected before and after algorithm implementation and between each PDSA cycle. The primary outcome measure included time from presentation to biopsy, which was monitored with a statistical process control chart. Several process measures were evaluated with Student's t-tests including administration of emergency pre-treatment. RESULTS: Nineteen patients pre-intervention and 52 patients post-intervention were included in the analysis. Time from presentation to biopsy significantly decreased from 48 hours at baseline to 24 hours post-implementation. Although not statistically significant, emergency pre-treatment decreased from a baseline of 26.3% to 6.7% post-implementation. CONCLUSION: Implementation of a diagnostic and management algorithm coordinating care among multi-disciplinary teams significantly reduced time to biopsy for children presenting with mediastinal mass and may result in decreased use of emergent pre-treatment. This article is protected by copyright. All rights reserved.