{
  "abstract": "Background Foreign 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.Aim To implement a locally developed guideline and educational intervention to improve adherence to best practice in the management of paediatric foreign body ingestion.Methods We 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.Results 27 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.Conclusion Introduction 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.",
  "authors": [
    {
      "affiliations": [
        "Department of Emergency Medicine, University Hospital Galway, Galway, Ireland"
      ],
      "name": "Wilhelmina Fouche"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University Hospital Galway, Galway, Ireland"
      ],
      "name": "Sinead McDonnell"
    },
    {
      "affiliations": [
        "Department of Radiology, University Hospital Galway, Galway, Ireland"
      ],
      "name": "Clare Roche"
    },
    {
      "affiliations": [
        "Department of Surgery, University Hospital Galway, Galway, Ireland"
      ],
      "name": "Amir Samy"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University Hospital Galway, Galway, Ireland",
        "School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland"
      ],
      "name": "James Binchy"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University Hospital Galway, Galway, Ireland",
        "School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland"
      ],
      "name": "James Foley"
    }
  ],
  "title": "Digesting the problem: standardising care for children who present to ED after ingesting foreign bodies",
  "uid": "14ddea51-1440-56a8-9913-11256b63c653"
}