P2.O288: Increasing documentation of Sexual Maturity Ratings in an Outpatient Pediatric Clinic

Purpose/Objectives: Puberty typically occurs between ages 8 to 14 years for girls and 9 to 15 years for boys, heralding a pivotal phase of physical, emotional, and social evolution. Accurate documentation of sexual maturity ratings (SMR) is essential as it facilitates early detection of aberrant development/delayed puberty, streamlines referrals to specialists, and aids in monitoring growth and development. Hence, it is imperative for pediatricians to consistently and precisely evaluate pubertal status. By improving documentation practices amongst providers in our community-based clinic, our quality improvement project aimed to address the diverse needs of pediatric patients including those related to gender identity and sexual health.

Design/Methods: The aim of this study was to increase documentation of Sexual Maturity Rating (SMR) during routine well-visits in the Children’s Health Center (CHC) in ages 8 to 18 years to 90% by May 2024. 3 PDSA (Plan-Do-Study-Act) cycles were implemented to achieve this goal. For the first PDSA cycle, pediatric residents received an email reminder to assign Tanner stages during every well visit for patients ≥ 8 years old with an attached Pediatrics In Review article highlighting the significance of SMR in monitoring puberty progression. The second PDSA cycle included placement of SMR diagrams in the clinic resident room to aid in visual reference. For the third PDSA cycle, reminders to assign SMR stages were placed in patient rooms.

Results: Prior to our interventions, baseline data was collected on breast and genital SMR staging for a sample of 60 patients (well child visits from ages 8-18) which showed appropriate documentation (including breast and pubic hair in females and testicular volume and pubic hair in males) was noted in only 5% of charts. After the implementation of our first PDSA cycle, 43% of analyzed charts had documented SMR staging (n=63). After our second PDSA cycle, 54% of analyzed charts had documented SMR staging which increased to 62% by the third PDSA cycle (n=60).

Conclusion/Discussion: Over the course of three PDSA cycles conducted, there has been an increase in documented GU exams and overall SMR staging within the outpatient pediatric clinic. More work is required to remind residents to stage both breast and pubic hair in female pediatric patients and pubic hair and testicular volume in male patients. Through this study, we were able to showcase that providing residents with educational material coupled with visual/written reminders can drive clinical improvements allowing for the overall well-being of our patients. Specifically, this project underscores the importance of ongoing quality improvement efforts particularly in enhancing SMR staging documentation in a general pediatrics clinic.