title: Let Us Use LET: A Quality Improvement Initiative.
abstract: BACKGROUND
  Well-managed pain is associated with faster recovery, fewer complications, and decreased use of resources. In children, pain relief is also associated with higher patient and parent satisfaction. Studies have shown that there are deficiencies in pediatric pain management. LET gel (lidocaine 4%, epinephrine 0.1%, and tetracaine 0.5%) is a topical anesthetic that is routinely used before laceration repair.
  
  
  OBJECTIVE
  The aim of this study was to determine if educational initiatives as part of a quality improvement initiative lead to increased rates of early topical anesthetic usage in a large urban pediatric emergency department.
  
  
  METHODS
  The initiative consisted of an educational session and a triage booth poster. We then reviewed the charts of patients with facial and scalp lacerations for the month before the initiative, the month after the initiative, and 1 year after the initiative. We assessed if LET gel usage and time to administration improved and were sustainable.
  
  
  RESULTS
  We reviewed 138 charts. Before the initiative, only 57.4% received LET gel before facial laceration repair with a mean time to application of 58.3 minutes. One month after the initiative, there was an increase in LET gel application by 20.1% with a reduction in time to application by 35.9 minutes (P < 0.05). In addition, these improvements were significantly sustainable. One year after the interventions, 82.4% received LET before facial laceration repair, and the time to LET application was 27.8 minutes.
  
  
  CONCLUSIONS
  Simple educational initiatives can improve the use of topical anesthetics. By using educational tools as part of a quality improvement initiative, we were able to significantly improve the rates of LET gel application for facial lacerations in children and decrease the time to administration.
authors.affiliation: From the *Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA; †Cohen Children's Medical Center of New York, NSLIJ Health System, New Hyde Park, NY; and ‡Connecticut Children's Medical Center, Hartford, CT.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Sherman
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheppard
authors.forename: Eric
authors.initials: E
authors.lastname: Hoppa
authors.forename: William
authors.initials: W
authors.lastname: Krief
authors.forename: Jahn
authors.initials: J
authors.lastname: Avarello
mesh_terms: D000287:Administration, Topical; D019162:Anesthetics, Combined / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002648:Child; D004338:Drug Combinations; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005782:Gels; D006801:Humans; D022125:Lacerations / Q000188:drug therapy*; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D059408:Pain Management / Q000379:methods*; D058996:Quality Improvement; D013748:Tetracaine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014218:Triage
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D004338:Drug Combinations; D005782:Gels; C111497:LET, anesthetic; D013748:Tetracaine; D008012:Lidocaine; D004837:Epinephrine