6917 Comparing educational interventions in quality improvement initiatives pertaining to the HEEADSSS assessment between regional and tertiary emergency departments

Objectives The Plan- Do- Study -Act (PDSA) cycle is a widely accepted quality improvement tool. There is an emerging body of evidence questioning the fidelity of its application in clinical environments in the context of quality improvement initiatives.1 Previous studies demonstrate the efficacy of educational interventions, synonymous with PDSA methodology, in raising the use of an adolescent psychosocial risk assessment tool 'HEEADSSS'.2 This study sought to further explore this hypothesis in the context of in two contrasting units; Our Lady of Lourdes Hospital (OLOL) Drogheda, a model 3 hospital, and CHI at Crumlin, a model 4 hospital, assessing their adherence to the WHO recommendation on the use of HEEADSSS.3 Methods The medical records of adolescent emergency department (ED) attendances in OLOL Drogheda between May and June 2022, and CHI Crumlin between April and June 2023, were retrospectively examined, extrapolating specific data points pertaining to the use of HEEADSSS. Staff questionnaires were sent out in advance, facilitating focused and bespoke educational interventions including staff education sessions, introduction of a blank proforma and lanyard attachments. Additional visual reminders were possible in the tertiary unit including, weekly emails and a 'HEEADSSS' screensaver on all ED desktops. A second, post intervention review was carried out in both units replicating data collecting methods used for initial reviews. The findings from both PDSA cycles were compared. Results In the regional unit 153 charts were reviewed (103 pre intervention and 50 post intervention. The improvement in the use of HEEADSSS was 57.3% for complete assessments and 50% for partial assessments. In the tertiary centre, 409 charts were reviewed (210 pre and 199 post). The improvement was 257% for complete assessments and 57.7% for partial assessments. Similar clinical characteristics were seen across all groups, with abdominal pain the most common presenting complaint. Conclusion The benefits of using the 'PDSA' cycle approach in the context of this dual centre quality improvement study are multiple. The interventions used were readily transferrable and effective in both units. Additionally, their efficacy was rapidly assessable, facilitating an improvement in strategies used in our duplicate, tertiary centre study. This translated to a greater overall improvement in the use of HEEADSSS in both a regional and tertiary paediatric centre. Further studies in this area should focus on unit specific barriers to change and the implications of such barriers in driving quality improvement initiatives in the emergency department. References McNicholas C, Lennox L, Woodcock T, Bell D, Reed JE. Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: a retrospective mixed-methods study. BMJ Quality 28(5), 356–365. https://doi.org/10.1136/bmjqs-2017-007605. Van Amstel LL, Lafleur DL, Blake K. Raising our HEADSS: adolescent psychosocial documentation in the emergency department. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 2004;11(6):648–655. The second decade: improving Adolescent Health and Development. Geneva: World Health Organization; 2001.