ArticleBMJ open quality2025
Digesting the problem: standardising care for children who present to ED after ingesting foreign bodies.
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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6 authors.
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Abstract
backgroundForeign body ingestion is a common reason for paediatric emergency department (ED) attendance. At baseline in our institution, only 55% of children were managed in accordance with international best practice. No local guideline was in place.
aimTo implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.
methodsWe conducted a quality improvement project in a single tertiary ED over 5 months, using three plan-do-study-act (PDSA) cycles. Interventions included guideline development, dissemination at NCHD induction and departmental teaching and case-based discussions. The SMART aim was to improve correct management from 55% to >80% within 5 months. The primary outcome measure was the proportion of cases managed correctly according to the guideline. Process measures were unnecessary imaging and inappropriate specialist referrals; return visits were tracked as a balancing measure. Data were analysed descriptively and displayed using a p-chart. Educational impact was explored with case vignettes.
results27 consecutive patients were included in the intervention period. Correct management increased from 55% at baseline to 87%-100% across PDSA cycles, exceeding the SMART aim. Process measures improved: unnecessary imaging decreased from 16% to 12% and inappropriate referrals from 3% to 0%. Avoidable return visits fell from 4% to 0%, without evidence of harm. Case vignette scores improved modestly (54%-63%), with variation across individual cases.
conclusionIntroduction of a locally developed guideline significantly improved adherence to best practice in paediatric foreign body ingestion. Improvements extended to process and balancing measures, demonstrating a true test of change. Embedding the guideline in induction, teaching and the hospital intranet is expected to support sustainability.
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