WIP 17 - Standardizing Practice, Optimizing Care: A Protocol for Management of Adolescent Menorrhagia in the Pediatric Emergency Department

Publication Number: WIP 17.7476

Rinitha Ravisankar, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Brooklyn, NY, United States; Sybille Moesta, Goryeb Children’s Hospital, Morristown, NJ, United States; Edward McCabe, Staten Island University Hospital, Staten Island, NY, United States; Aviva G. Dworkin, Icahn School of Medicine at Mount Sinai/ Elmhurst Hospital-NYCHHC, Elmhurst, NY, United States; Eleny Romanos-Sirakis, Siuh northwell, Staten Island, NY, United States; Yvonne Giunta, Northwell Health, Holmdel, NJ, United States; Joanna Pierro, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, United States

Background: Heavy menstrual bleeding (HMB) affects up to 16% of adolescent women in the US and is a common complaint in the pediatric emergency department (ED). Despite this, significant variations exist in management, even within single institutions, which can delay optimal treatment. Management of active bleeding, treatment of iron deficiency anemia (IDA), and referral patterns in the ED traditionally show the greatest variations in treatment. Standardizing the approach to these issues has the potential to improve outcomes.

Objective: The primary objectives of this quality improvement project are to implement the use of norethisterone for patients with active bleeding, increase the percentage of iron-deficient anemia (IDA) patients receiving iron, and enhance referrals to Adolescent Medicine and Hematology for patients with HMB presenting to the ED.

Design/Methods: This is an IRB-exempt single-center study aiming to standardize the management of adolescent patients presenting to the pediatric ED with HMB. A treatment algorithm was implemented in the pediatric ED of Staten Island University Hospital in early 2024. Pre-implementation data of 46 patients revealed that active bleeding was addressed in 13% of patients while 10.9% of patients with anemia were prescribed an appropriate dose of iron, and only 4.35% were referred to hematology. Pilot post-implementation data (n=8) revealed a significant improvement in the treatment of active bleeding (37.5%), proper iron utilization (37.5%), and hematology referrals (62.5%). Implementing a standardized protocol for adolescent patients presenting to the ED with HMB is feasible and can improve outcomes. We plan to focus future efforts on increased implementation of this protocol. Pre- and post-implementation data will be analyzed using a t-test after data collection is completed in February 2025.