ArticleBMJ open quality2025
Counting the seconds: a quality improvement initiative to accelerate intraoperative results for arthrocentesis cell counts in a paediatric tertiary care hospital.
Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn paediatric patients with concern for septic arthritis, arthrocentesis may be performed under anaesthesia with intraoperative cell count determining need for surgical intervention. Shorter turnaround time (TAT) between collection and result minimises anaesthesia exposure for the patient and surgical time for the treatment team. This study evaluated a quality improvement (QI) initiative to decrease TAT to <1 hour by improving interdisciplinary communication and placing visual reminders ('stat card') to indicate priority handling.
methods206 consecutive paediatric patients who underwent arthrocentesis for the diagnosis of septic arthritis were identified. Midway through the collection period, the QI intervention (stat card) was implemented. We collected the date and time of arthrocentesis and sample verification (TAT) and calculated the proportion of TAT <1 hour preintervention and postintervention. We collected variables related to the affected joint and whether the stat card was used. Operative time was calculated for those samples collected in the Operating Room (OR).
resultsThe final study population included 109 patients preintervention and 88 patients postintervention. Postintervention, the stat card was used in only 44% (20/45) of eligible cases. Compliance was highest in aspirations of the hip (75%). After adjusting for the affected joint, the odds of TAT <1 hour were higher in the postintervention stat card group compared with the postintervention no stat card group (odds ratio 7.10, p=0.0147) and to the preintervention group (odds ratio 3.63, p=0.0810). There was no difference between the postintervention no stat card versus the preintervention groups (odds ratio 0.51, p=0.2524). TAT was significantly decreased when the stat card was used (42 min) compared with when it was not used (84 min) (mean difference -39.5%, p=0.0178). After adjusting for the affected joint, there was no difference in operative time across the three groups (p=0.2531).
conclusionA multidisciplinary QI initiative for the intraoperative diagnosis of septic arthritis was effective in reducing cell count TAT but demonstrated poor compliance and failed to reduce operative time.
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