1.5 QI Examples Within the Hospital Network

A pediatric ED team asked: How can we increase follow-up call completion after emergency department discharge for behavioral health visits? They started with a baseline measurement showing only 40% of families received a follow-up call within 48 hours. The team tested a structured reminder system using small PDSA cycles, starting with one nurse on one shift. After learning that the reminder worked but nurses didn’t have a quiet space to make calls, they adjusted by designating a “call-back station” during low-volume hours.

Result: Completion rates improved from 40% to 85% in six months. Family satisfaction scores for the follow-up experience also improved significantly.

A hospital with variable screening rates asked: How can we ensure every adolescent presenting to the ED receives consistent suicide risk screening? Baseline data showed screening rates of 60% overall, with wide variation by shift (90% day, 45% night). They introduced an EMR prompt during triage that auto-populated the screening tool and trained nurses on next steps after a positive screen, including a “positive screen pathway” that triggered an automatic behavioral health consult.

Result: Screening rates increased from 60% to 95%, with night shift rates improving to 91%. The number of identified at-risk youth and early interventions increased proportionally.

A PMHCA team asked: How can we improve family engagement during a child’s mental health crisis? They started by interviewing 10 families about their ED experience. Families reported feeling “left in the dark” and “like we were in the way.” The team co-designed a family engagement script with nurses, social workers, and caregivers — iterating through several PDSA cycles. The script included introductions by name, updates every 30 minutes, and a printed “What to Expect” handout.

Result: Family satisfaction scores rose by 20%, and staff reported improved communication and fewer escalated family complaints. Nurses also reported that the script reduced their anxiety about managing difficult conversations.

A regional EMS system asked: How can we ensure youth in behavioral health crisis are transported to the most appropriate facility? Baseline data showed 58% of pediatric behavioral health transports went to the nearest ED regardless of psychiatric capability. The EMS Medical Director worked with receiving facilities to establish destination criteria and developed a laminated decision card for crews. The pilot was tested with 4 units over 6 weeks.

Result: Appropriate-destination transport rates improved from 42% to 78%. Secondary transfers decreased by 35%, reducing total time-to-definitive-care for affected patients.

Each project started with a focused improvement question, used QI methods to test change, and measured outcomes that mattered to patients, families, and providers. None of these projects required new funding, new hires, or years of planning. They required curiosity, structure, and the willingness to start small.