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2025 ; 18
(1
): 217
Nephropedia Template TP
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Improving patient outcomes through quality improvement and safety culture
interventions in pediatric emergency care: a systematic review of best practices
#MMPMID41131478
Onyejesi CD
; Elsayed SM
; Daniel Isaac JM
; Abady EM
; Shehada W
; Alhaddad J
; Alsabri M
Int J Emerg Med
2025[Oct]; 18
(1
): 217
PMID41131478
show ga
Pediatric emergency departments (PEDs) are high-risk environments where patient
injury can result from delays, unclear diagnoses, and poor communication. Quality
improvement (QI) and safety culture initiatives are increasingly being used to
improve outcomes, but their interaction in PEDs remains underexplored. This
systematic review and meta-analysis evaluated how safety culture and QI
initiatives impact clinical and functional outcomes in PEDs. In accordance with
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines, we systematically searched PubMed, Cochrane, Scopus, and Web of
Science through December 2024. We included 31 studies, most of which used
pre/post designs; one was a randomized controlled trial. Most interventions aimed
to improve care in PEDs by focusing on protocol standardization, safety
checklists, simulation-based training and leadership engagement tailored to the
pediatric emergency department (PED) setting. Meta-analyses showed a significant
decrease in unnecessary radiation exposure (6.45%-20.55%; p<0.0001) and PED
length of stay (LOS) (~25 minutes; p<0.05). Additional findings included
decreased healthcare expenses, unnecessary interventions, and better patient
flow. Most studies were at moderate risk of bias across the assessed domains with
ROBINS-I tool. . These findings suggest that QI techniques can significantly
improve the quality and efficiency of care when supported by a strong safety
culture. These results show how essential it is to bring together both practical
processes and cultural changes to build reliable, lasting systems that truly meet
the unique needs of PEDs.