Background/Purpose: Timely treatment for juvenile idiopathic arthritis (JIA) is essential for disease remission and decreasing risk of long-term morbidity. Intra-articular corticosteroid joint injections can treat active arthritis. If a joint injection cannot be completed in the outpatient clinic due to sedation needs, additional steps must be made to schedule the procedure, often delaying treatment. Using quality improvement (QI) methodology, this study aims to reduce the time to completion of joint injection for patients in our pediatric rheumatology clinic.

Methods: Our QI team reviewed all clinic encounters of JIA patients from September 2023 to March 2025. We obtained a baseline number of joint injections per month for the initial 8 months and the percentage of those that were completed within 30 days. A new monthly joint injection clinic was started in collaboration with the surgery center for sedated joint injections. Scheduling processes for joint injections were implemented as standardized forms for nursing and provider workflows within the electronic health record (EHR). The number of patients receiving joint injections and the time to completion were tracked monthly using control charts. To further evaluate the new workflows, a survey was administered to providers, trainees, and nurses.

Results: During the study period, 166 patients received joint injections, and 137 (82%) were completed within 30 days. During the baseline period, there was a mean completion rate of 90%. As we continued standardization processes and implementing interventions, there was a decrease in joint injections completed in 30 days resulting in a new process stage mean of 74% (Figure 1). When looking at average number of days until joint injection completion, the initial baseline mean was 12 days but increased to 20 days after the new process stage mean was established. The median average of days until injection completion was 15.5 days (Figure 2). Factors contributing to decrease in mean included: 1) transition to a new surgery center location in May 2024 and 2) decreased availability of sedated procedures over the holiday months of November- December 2024. Provider and staff survey results showed agreement that our new workflows have streamlined communication for details of the procedures to surgery center staff, simplified the scheduling process, decreased the number of messages needed to schedule procedures, and increased the procedure opportunities for fellow trainees. Respondents felt that length of time to schedule a joint injection was closely split between decreased (46%) and no difference (47%) (Figure 3).

Conclusion: This ongoing QI study demonstrates that implementation of a standardized form used by nursing and physician workflows within the EHR helped create a streamlined process for scheduling and completing corticosteroid joint injections within a 30-day window.

Figure 1: Control chart showing percentage of joint injections completed per month.

Figure 2: Control chart showing number of days for joint injections to be completed per month.

Figure 3: Survey results regarding usefulness of standardized form for joint injections within the electronic health record.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-access-to-timely-joint-injections-for-pediatric-rheumatology-patients-a-quality-improvement-initiative/