Championing better care for adolescents with iron deficiency: Highlighting the impact of quality improvement initiatives

In the fast-paced environment of emergency medicine, adolescents with heavy menstrual bleeding and iron deficiency anemia (IDA) often receive inconsistent care, in part due to a lack of standardized guidelines. This gap can result in prolonged health challenges and potentially avoidable visits to the emergency department (ED) for ongoing symptomatic IDA. Inspired by these issues, my team embarked on a multidisciplinary quality improvement initiative at Texas Children’s Hospital. This project recently earned recognition by the American Society of Hematology as part of its inaugural Quality Improvement Champions program.

The challenge: Closing gaps in diagnosis and care

Adolescents with heavy menstrual bleeding often are underdiagnosed and undertreated for iron deficiency anemia. Our team identified this issue in 2020, as only 9% of patients seen at our ED received iron supplementation, despite 78% showing iron deficiency and 92% meeting the criteria for anemia. This lack of standardized screening and treatment illuminated a critical need for intervention.

To address these gaps, we implemented a quality improvement initiative, which started with the development of an evidence-based algorithm to guide the evaluation, treatment and disposition of adolescents presenting with heavy menstrual bleeding. Our goal was to ensure consistent and equitable care for this underserved population.

Quality improvement in action

The success of our initiative was rooted in multidisciplinary collaboration, with input from hematologists, gynecologists, emergency physicians and hospitalists. Together, we created a framework that aligned with evidence-based recommendations while addressing the practical challenges of implementation in a busy academic center.

Key interventions included education sessions for providers, easy access to the algorithm and ongoing engagement with clinical teams. Despite barriers such as provider turnover, these measures ensured the initiative’s sustainability.

The results were transformative:

• Adherence to appropriate therapy choice (intravenous versus oral iron, with or without blood transfusion) increased to 100% from 57%.
• Hematology consultations rose to 100% from 36%.
• Appropriate patient dispositions (discharge versus hospital admission) improved to 100% from 71%.

These findings, recently published in Pediatric Blood & Cancer, highlight the profound impact of quality improvement initiatives on patient outcomes.

Why quality improvement matters

This project reaffirmed my belief in the power of quality improvement to address disparities and elevate care. Iron deficiency impacts not only physical health but also school performance, mental well-being and overall quality of life for adolescents. By standardizing care, we ensured every patient received timely and appropriate treatment, regardless of provider variability.

The recognition from the American Society of Hematology is not just a personal milestone but a validation of the importance of quality improvement in hematology. I am honored to present our work at the 66th ASH Annual Meeting and Exposition in December 2024, and I hope it inspires others to prioritize quality improvement in their practices.

Looking ahead

Quality improvement is more than just process optimization – it’s about ensuring equitable and effective care for all patients. Our team’s success demonstrates how collaboration and evidence-based strategies can drive lasting change. I look forward to seeing similar initiatives flourish across institutions, making a meaningful difference in the lives of patients and their families.

By Dr. Josaura Fernandez Sanchez, Assistant Professor of Pediatrics – hematology/oncology and stem cell transplantation, Texas Children’s Cancer and Hematology Centers, Baylor College of Medicine