Introduction: Efficient access to pediatric mental health services is a growing concern as the number of patients increases and outpaces efforts to expand services. This study outlines interventions implemented using quality improvement (QI) science and methodology to demonstrate how a clinic embedded in a large children’s hospital can improve access to the first appointment for a population seeking pain management services. Methods: A process improvement project started with a QI team, whose members designed interventions to change scheduling practices. Initial changes involved decreased time between calls to families, and efforts to streamline notifications among clinicians. Additional interventions included a close examination of waitlist assignment based on appropriateness and assessing patient interest in treatment. Results: Within 3 months of implementation, a significant decline in wait time occurred for patients seeking services for pain management, from 106 to 48 days. This change remained stable for 6 months. In light of a sharp increase in referrals and wait time during the study period, efforts to engage additional clinicians in managing referrals resulted in wait time to stabilize at an average of 63 days to the first appointment. This change remained for 10 months. Scheduling changes did not negatively affect other providers. Conclusions: This study demonstrates the application of QI science to improve patient access to mental health care. Future directions will focus on enhancing the use of the electronic health record, along with previsit family engagement.

Background:Radiographs are frequently ordered for general musculoskeletal complaints in the outpatient setting. However, incorrect laterality, incorrect location, or unnecessary radiographs have been reported as errors in our clinics. This quality improvement (QI) project aimed to reduce incorrect duplicate radiographs in outpatient pediatric sports medicine clinic. The overall global goal was to stop unnecessary radiation exposure in our pediatric patients.Methods:Using QI methodology, we evaluated the current clinic flow, the process of ordering radiographs, and the completion of radiographs at the main sports medicine outpatient clinic. Staff communication, staff education, and patient participation were identified as the prominent gaps in our clinic process. We implemented interventions using progressive biweekly Plan-Do-Study-Act (PDSA) cycles to promote change and to reduce our radiographic errors.Results:Retrospective baseline data demonstrated baseline errors of 9% (10/106) in the main outpatient clinic. After 6 months of PDSA cycles, we found no duplicate errors. Highly successful interventions included radiograph screening survey for families, staff education, and improved staff communication. The project was expanded to a second outpatient clinic with baseline errors of 6% (4/64). After 2 months of PDSA cycles, no duplicate errors were found.Conclusion:Our goal was to reduce incorrect duplicate radiographs in outpatient sports medicine clinic and limit unnecessary radiation exposure in our pediatric patients. A reduction in duplicate errors at 2 clinics occurred using the Institute for Healthcare Improvement model to facilitate change. Effective communication between physicians, clinical athletic trainers, radiology technologists, patients, and families drove the success of this quality improvement initiative.

Background Given the impact of psychological factors on rheumatic disease, pediatric psychologists serve a vital role in promoting quality of life and managing common problems among youth with rheumatic disease. The aim of this project was to increase access to psychological services among youth with rheumatic disease at a children’s hospital. Methods A quality improvement (QI) team identified key drivers and interventions aimed to increase access to psychological services for youth with rheumatic disease. Data was collected for a 6-month baseline period and 4-year intervention period. We applied the Plan-Do-Study Act method of QI and the American Society for Quality criteria to adjust the center line and control limits. Results There were two statistically significant center line shifts in the number of patients seen by psychology and one statistically significant shift in referrals to psychology over time with applied stepwise interventions. Patients seen by a psychologist increased by 3,173% from a baseline average of 1.8 to 59.9 patients seen per month (p < 0.03). Psychology referrals increased by 48% from a baseline average of 9.85 to 14.58 referrals per month over the intervention period (p < .01). Conclusions Youth with rheumatic disease received increased access to mental health treatment when psychological services were imbedded within rheumatology care. Psychology referrals also increased significantly, suggesting that psychology integration within a medical clinic can increase identification of needs. Results suggest that psychology integration into rheumatology care may increase access to mental health treatment and identification of psychological needs in this at-risk population.

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