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Journal Cover Pediatric Quality & Safety
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  This is an Open Access Journal Open Access journal
   ISSN (Online) 2472-0054
   Published by LWW Wolters Kluwer Homepage  [290 journals]
  • Reducing Interdisciplinary Communication Failures Through Secure Text
           Messaging: A Quality Improvement Project

    • Authors: Hansen; Jesse E.; Lazow, Margot; Hagedorn, Philip A.
      Abstract: Introduction: Interdisciplinary communication failures contribute to medical mistakes and adverse events. At our institution, provider communication previously occurred through unidirectional pager systems. We utilized quality improvement methodology to (1) implement a secure text messaging system for providers on a pediatric ward and (2) evaluate its impact on communication failures. We aimed to reduce potential communication failures between providers by> 25% within 1 month.Methods: Implementation of secure text messaging occurred via Plan-Do-Study-Act cycles focused on education, feedback, and electronic health record interventions. We collected pager data before implementation and both pager and secure text messaging data after intervention. Potential communication failures were identified a priori through manual review of the messaging data to capture lack of closed-loop communication. A run chart was used to track daily potential communication failures and total communication volumes.Results: Before implementation of secure text messaging, the median daily potential communication failure rate was 5.5%. Usage of secure text messaging increased after implementation, representing 3.5 of 7.2 communications per patient-day. Paging communications decreased from 4.2 to 3.7 per patient-day. Potential communication failures decreased to a median daily rate of 2.2%, representing a 59% reduction in communication failures.Conclusion: Implementation of secure text messaging using quality improvement methods resulted in a significant reduction in potential communication failures between residents and nurses. Future interventions will be aimed at maintaining and augmenting providers’ use of secure text messaging to ensure the potential for communication failure remains low.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online February 6, 2018.Presented at the Pediatric Hospital Medicine Poster Session, July 2017, Nashville, TN and the American Academy of Pediatrics (AAP) National Conference and Exhibition, Chicago, IL, September 2017.Supplemental digital content is available for this article. Clickable URL citations appear in the text.To cite: Hansen JE, Lazow M, Hagedorn PA. Reducing Interdisciplinary Communication Failures Through Secure Text Messaging: A Quality Improvement Project. Pediatr Qual Saf 2018;3:1.*Corresponding author. Address: Philip Hagedorn, MD, 3333 Burnet Ave, MLC 3024, Cincinnati, OH 45229 PH: (513)636-6593. FAX: (513)803-9244., Email: philip.hagedorn@cchmc.orgReceived for publication May 25, 2017; Accepted December 27, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Tue, 06 Feb 2018 00:00:00 GMT-
       
  • A Quality Improvement Initiative to Increase and Sustain Influenza
           

    • Authors: Wong; Chris I.; Billett, Amy L.; Weng, Shicheng; Eng, Kelly; Thakrar, Usha; Davies, Kimberly J.
      Abstract: Introduction: Influenza vaccination of pediatric oncology and stem cell transplant (SCT) patients is crucial due to high risk of complications. Achieving high vaccination rates to prevent illness is often limited by competing demands and intensive treatment. A quality improvement (QI) initiative beginning influenza season 2012–2013 aimed to achieve and sustain high vaccination rates in active patients> 6 months of age, receiving cancer therapy or SCT within 6 months before or at any time during the season, and> 100 days after allogeneic SCT.Methods: We identified key drivers and barriers to success from an initially developed vaccination process that proved to be burdensome. Change ideas were implemented through multiple tests of change during the QI initiative. Iterations within and across 4 subsequent seasons included patient identification through chemotherapy orders, provider education, incorporating vaccination into routine work-flow, continuous data analysis and feedback, and use of new reporting technology.Results: Initial vaccination rates were < 70%, increasing to 89% after the QI initiative began and subsequently sustained between 85% and 90%. Active patients were significantly more likely to be vaccinated during the initiative (odds ratio, 3.7; 95% CI, 2.9–4.6) as compared with the first 2 seasons.Conclusions: High influenza vaccination rates can be achieved and maintained in a pediatric oncology/SCT population using strategies that correctly identify patients at highest risk and minimize process burden.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online January 5, 2018Preliminary data were presented as a poster at the 2015 Annual Meeting of the American Society of Pediatric Hematology-Oncology.To cite: Wong CI, Billett AL, Weng S, Eng K, Thakrar U, Davies KJ. A Quality Improvement Initiative to Increase and Sustain Influenza Vaccination Rates in Pediatric Oncology and Stem Cell Transplant Patients. Pediatr Qual Saf 2018;1:e052.Received for publication July 28, 2017; Accepted November 17, 2017.*Corresponding author. Address: Chris I. Wong, MD, MPH, Department of Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Dana 3, Boston, MA 02215, PH: 617-632-5996; Fax: 617-632-4410, Email: chris_wong@dfci.harvard.eduCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • A Quality Improvement Collaborative for Pediatric Sepsis: Lessons Learned

    • Authors: Paul; Raina; Melendez, Elliot; Wathen, Beth; Larsen, Gitte; Chapman, Laura; Wheeler, Derek S.; Wakefield, Toni; Macias, Charles G.
      Abstract: Background: Sepsis is a leading cause of morbidity and mortality in children worldwide. Barriers exist for timely recognition and management in emergency care settings. This 1-year quality improvement collaborative sought to reduce mortality from sepsis.Methods: Fifteen hospitals participated initially. We included children with a spectrum of illness from sepsis to septic shock. The intervention bundle focused on recognition, escalation of care, and the first hour of resuscitation. We conducted monthly learning sessions and disseminated data reports of site-specific and aggregated metrics to drive rapid cycle improvement.Results: Seven sites contributed enough data to be analyzed. Of the 1,173 pediatric patients in the total cohort, 506 presented with severe sepsis/septic shock. Quarterly data demonstrated a mean improvement in initial clinical assessment from 46% to 60% (P < 0.001) and in adherence to the administration of first fluid bolus within 15 minutes from 38% to 46% (P < 0.015). There was no statistically significant improvement in other process metrics. There was no statistically significant improvement in mortality for the total cohort (sepsis to septic shock) or either of the subgroups in either 3- or 30-day mortality.Conclusions: A quality improvement collaborative focused on improving timely recognition and management of pediatric sepsis to septic shock led to some process improvements but did not show improvement in mortality. Future national efforts should standardize definitions and processes of care for sepsis to septic shock, including the identification of a “time zero” for measuring the timeliness of treatment.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Published online December 29, 2017Preliminary data presented at the American Academy of Pediatrics National Conference and Exhibition, October 21, 2016, San Francisco, Calif.To cite: Paul R, Melendez E, Wathen B, Larsen G, Chapman L, Wheeler DS, Wakefield T, Macias CG. A Quality Improvement Collaborative for Pediatric Sepsis: Lessons Learned. Pediatr Qual Saf 2018;3:1.Received for publication November 27, 2016; Accepted November 16, 2017.*Corresponding author. Address: Charles G. Macias, MD, MPH, 6621 Fannin Street, Suite A2210, Houston, TX 77030., PH: 832-824-5416 FAX: 832-825-1182, Email: cgmacias@texaschildrens.orgCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Using Length of Stay to Understand Patient Flow for Pediatric Inpatients

    • Authors: Stockwell; David C.; Thomas, Cherie; Fieldston, Evan S.; Hall, Matt; Czaja, Angela S.; Stalets, Erika L.; Biehler, Jefry; Sheehan, Maeve; Foglia, Dorothy; Byrd, Susan; McClead, Richard E.
      Abstract: Objectives: Develop and test a new metric to assess meaningful variability in inpatient flow.Methods: Using the pediatric administrative dataset, Pediatric Health Information System, that quantifies the length of stay (LOS) in hours, all inpatient and observation encounters with 21 common diagnoses were included from the calendar year 2013 in 38 pediatric hospitals. Two mutually exclusive composite groups based on diagnosis and presence or absence of an ICU hospitalization termed Acute Care Composite (ACC) and ICU Composite (ICUC), respectively, were created. These composites consisted of an observed-to-expected (O/E) LOS as well as an excess LOS percentage (ie, the percent of day beyond expected). Seven-day all-cause risk-adjusted rehospitalizations was used as a balancing measure. The combination of the ACC, the ICUC, and the rehospitalization measures forms this new metric.Results: The diagnosis groups in the ACC and the ICUC included 113,768 and 38,400 hospitalizations, respectively. The ACC had a median O/E LOS of 1.0, a median excess LOS percentage of 23.9% and a rehospitalization rate of 1.7%. The ICUC had a median O/E LOS of 1.1, a median excess LOS percentage of 32.3%, and rehospitalization rate of 4.9%. There was no relationship of O/E LOS and rehospitalization for either ACC or ICUC.Conclusions: This metric shows variation among hospitals and could allow a pediatric hospital to assess the performance of inpatient flow.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 18, 2017Supported, in part, by the Children’s Hospital Association. Dr. Stockwell reports partial employment by Pascal Metrics, a federally certified Patient Safety Organization. The other authors have no financial relationships to disclose.Received for publication March 20, 2017; Accepted November 13, 2017.*Corresponding author. Address: David C. Stockwell, MD, MBA, Children’s National Medical Center, 111 Michigan Ave., NW, Suite M-4800, Washington, DC 20010 PH: 202-476-2130; FAX: 202-476-5724. Email: dstockwell@childrensnational.orgCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving
           Sustainability

    • Authors: Bodily; Stephanie A.; Delgado-Corcoran, Claudia; Wolpert, Katherine; Lucas, Kathryn; Presson, Angela P.; Bratton, Susan L.
      Abstract: Introduction: Frequent blood testing increases risk of iatrogenic anemia, infection, and blood transfusion. This study describes 3 years of sustained blood testing reduction from a quality improvement (QI) initiative which began in 2011.Methods: The cohort consisted of postop children whose surgery had a Risk Adjustment for Congenital Heart Surgery (RACHS) classification consecutively admitted to a tertiary Cardiac Intensive Care Unit. Data were collected for a 2010 preintervention, 2011 intervention, and 2012–13 postintervention periods, tabulating common laboratory studies per patient (labs/pt) and adjusted for length of stay (labs/pt/d). The QI initiative eliminated standing laboratory orders and changed to testing based on individualized patient condition. Adverse outcomes data were collected including reintubation, central line–associated bloodstream infections and hospital mortality. Safety was measured by the number of abnormal laboratory studies, electrolyte replacements, code blue events, and arrhythmias.Results: A total of 1169 patients were enrolled (303 preintervention, 315 intervention, and 551 postintervention periods). The number of labs/pt after the QI intervention was sustained (38 vs. 23 vs. 23) and labs/pt/d (15 vs. 11 vs. 10). The postintervention group had greater surgical complexity (P = 0.002), were significantly younger (P = 0.002) and smaller (P = 0.008). Children with RACHS 3–4 classification in the postintervention phase had significant increased risk of reintubation and arrhythmias.Conclusions: After the implementation of a QI initiative, blood testing was reduced and sustained in young, complex children after heart surgery. This may or may not have contributed to greater reintubation and arrhythmias among patients with RACHS 3–4 category procedures.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 7, 2017Presented as Poster Board at Cardiology 2015 in 18th Annual Update of Pediatric and Congenital Cardiovascular Diseases, February 11–15, 2015, Scottsdale, Ariz.Supplemental digital content is available for this article. Clickable URL citations appear in the text.To Cite: Bodily SA, Delgado-Corcoran C, Wolpert K, Lucas K, Presson AP, Bratton SL. Reducing Blood Testing in Pediatric Patients after Heart Surgery: Proving Sustainability. Pediatr Qual Saf 2017;2:e047.Received for publication November 3, 2016; Accepted October 21, 2017.*Corresponding Author: Address: Stephanie Bodily, MSN, NP, Department of Pediatric Critical Care, Primary Children’s Hospital, 100 N. Mario Capecchi Dr, Salt Lake City, UT 84113, PH: 801-662-2445; Fax: 801-662-2469 Email: stephanie.bodily@imail.orgCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic

    • Authors: Ratliff-Schaub; Karen; Valleru, Jahnavi
      Abstract: Background: Online patient portals are not widely used, despite their advantages for efficient communication, especially for patients with chronic conditions. A hospital-based group practice of Developmental-Behavioral Pediatricians initiated this quality improvement (QI) project with a goal to increase the percentage of patients with an active MyChart (Epic Systems Corporation’s patient portal) account and ultimately improve efficiency of communication between families and clinical staff.Methods: Using QI methodology, we identified staff commitment, workflow issues, and family awareness as gaps and implemented progressive Plan, Do, Study, Act cycles aimed at developing standard processes for activating families on MyChart. We tracked our project measures with statistical process control methodology and sustained our progress with improving awareness and regular feedback.Results: Patient portal activations increased from 1.8% to 30% in a 6-month time period. Highly successful interventions included development and implementation of a standard process for activation, staff education to ensure comfort and commitment, having families opt out instead of opt in, and completed activation of accounts before families leaving clinic.Conclusions: Patient portal activation can be significantly increased through systematic application of QI methodology to address staff training and workflow in a busy subspecialty clinic. Engagement of operations staff and completion of the activation process while the family is still in clinic seemed to be effective in getting families activated in MyChart. It is possible to improve patient portal activation with minimal impact to workflow.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 5, 2017To cite: Ratliff-Schaub K, Valleru J. Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic. Pediatr Qual Saf 2017;2:e049.Received for publication May 12, 2017; Accepted November 2, 2017.*Corresponding author. Address: Karen Ratliff-Schaub, MD, MBOE, Developmental Behavioral Pediatrics, 700 Children’s Drive, Columbus, OH 43205 PH: 614-722-2460; FAX: 614-722-4451, Email: Karen.Ratliff-Schaub@nationwidechildrens.orgCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Improving Human Papilloma Virus Vaccination Rates: Quality Improvement

    • Authors: Bowden; Michelle; Yaun, Jason; Bagga, Bindiya
      Abstract: Background: Human papilloma virus (HPV) is a sexually transmitted infection with a national prevalence of greater than 70 million. Most infections are among persons 15–24 years of age. The HPV vaccine has nearly 100% efficacy when administered before natural exposure. However, national vaccination rates remain less than 50%. Our objective was to improve the rate of initiation of the HPV vaccination series in a resident teaching practice.Methods: We used the Plan Do Study Act methodology for quality improvement. Eligible patients included children 9 through 13 years of age who presented to a general pediatric clinic. We established baseline data by reviewing HPV immunization rates taken from a convenience sample of ≤20 patients per month over 7 months. A key driver diagram guided interventions including resident communication, nursing staff education, family knowledge, and an electronic medical record prompt beginning at age 9. Using standard run chart rules, we plotted monthly postintervention vaccination rates over 7 months of data collection.Results: Baseline data included 136 patients age 9–13. Run chart monitoring revealed an increase in our HPV vaccination rate from 53% at baseline to 62% by October 2015. Additionally, we observed a statistically significant increase in mean vaccination rates from 50% to 69% (odds ratio 2.071; P = 0.0042). We noted an increase in vaccination rates after resident education initiatives and after implementation of an electronic medical record prompt.Conclusions: Simple and practical interventions involving residents led to a marked increase in HPV vaccination in our patient population.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Published online December 4, 2017To Cite: Bowden M, Yaun J, Bagga B. Improving Human Papilloma Virus Vaccination Rates: Quality Improvement. Pediatr Qual Saf 2017;2:e048.Received for publication March 29, 2017; Accepted October 15, 2017.*Corresponding author. Address: Michelle Bowden, MD, Le Bonheur Children’s Hospital, 49 N. Dunlap, Memphis, TN 38103, PH: 901-287-6292; Fax: 901-287-5387, E-mail: mroark3@uthsc.eduCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality
           Improvement Approach to Antimicrobial Stewardship

    • Authors: Quintos-Alagheband; Maria Lyn; Noyola, Estela; Makvana, Sejal; El-Chaar, Gladys; Wang, Shan; Calixte, Rose; Krilov, Leonard R.
      Abstract: Objective: The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood.Methods: Baseline data from the 2011–2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards.Results: We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation.Conclusion: Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online December 1, 2017Supplemental digital content is available for this article. Clickable URL citations appear in the text.What’s known on this subject: 50% of antimicrobial utilization is inappropriate, which includes misuse in viral infections. RSV is the most common cause of pediatric bronchiolitis. Per AAP guidelines, antibiotics should only be used if there are specific indications of coexisting bacterial infection in RSV.What this study adds: Utilization of antibiotics in RSV is common, despite published guidelines. Implementation of ASP through ramping PDSA cycles led to a safe reduction in antibiotic utilization in RSV. This article demonstrates that by narrowing the scope of the project to RSV initially, foundation for a successful and sustained formal ASP is possible.To Cite: Quintos-Alagheband ML, Noyola E, Makvana S, El-Chaar G, Wang S, Calixte S, Krilov LR. Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship. Pediatr Qual Saf 2017;2:e046*Corresponding author. Address: Maria Lyn Quintos-Alagheband, MD, Department of Pediatrics, Children’s Medical Center, NYU Winthrop University Hospital, 259 First Street, Mineola, NY 11501, PH: 516 663 6920; Fax: 516 663 8955, Email: lquintos@nyuwinthrop.orgReceived for publication January 19, 2017; Accepted October 15, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care
           Unit

    • Authors: Ganesan; Rani; Rajakumar, Priya; Fogg, Louis; Silvestri, Jean; Kane, Jason M.
      Abstract: Objective: To implement a daily rounding tool in a pediatric intensive care unit (PICU) to improve the discussion performance of identified clinical elements. We hypothesized that a semi-structured rounding tool created by a multidisciplinary team would be successfully implemented and sustained in the PICU.Patients and Methods: A pre–post interventional study was conducted in a multidisciplinary medical-surgical PICU. Baseline data collection of undisclosed clinical elements was performed by covert observers, which resulted in the development of a comprehensive, nurse-driven rounding checklist. Frequencies of pre- and postintervention metrics were assessed after implementation, and sustainability was assessed at 5 years.Results: Six months after implementation, 70% (7/10) of checklist elements demonstrated significant improvement. Five years after implementation, 172 of a possible 222 (74%) checklists were collected. Eighty percentage (8/10) of the measures sustained discussion frequency after 5 years of use. Nursing presence significantly improved at year 5 compared with the preimplementation period. Nursing satisfaction surveys distributed at year 5 showed that the rounding tool was useful and nurses were confident in understanding care plans at the end of rounds. Ninety-eight percentage of checklists revealed discrete transcription of qualitative daily goals.Conclusions: A semi-structured rounding tool created by a multidisciplinary team was successfully implemented, and performance was sustained at 5 years. This initiative led to improved bedside nursing presence during patient care rounds.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Published online November 17, 2017Received for publication February 22, 2017; Accepted August 29, 2017.To Cite: Ganesan R, Rajakumar P, Fogg L, Silvestri J, Kane JM. WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care Unit. Pediatr Qual Saf 2017;2:e044.Supplemental digital content is available for this article. Clickable URL citations appear in the text.Assistance with the study: Ruth Kleinpell, PhD, RN, FAAN, FCCM, Professor, Rush University College of Nursing, Director, Center for Clinical Research and Scholarship, Rush University Medical Center, Chicago, Ill.Poster presented at American Academy of Pediatrics Annual National Conference and Exhibition, October 2011, Boston, Mass. (Ganesan R, Conley L, Kane J: Development of “WE CARE 4 KIDS” Rounding Checklist in the Pediatric Intensive Care Unit); and at the Society of Critical Care Congress, February 2012, Houston, Tex. (Ganesan R, Rajakumar P, Conley L, Nelson S, Kane J: Structured Rounding Checklist Improves Quality of Care in the PICU).*Corresponding author. Address: Rani Ganesan, MD, Department of Pediatrics, Rush University Medical Center, 1653 West Congress Parkway Pavilion 565, Chicago, IL 60612, PH: 312 942 6194; FAX: 312 942-6145, E-mail: Rani_Ganesan@rush.eduCopyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House
           Officers

    • Authors: Keefer; Patricia; Helms, Lauren; Warrier, Kavita; Vredeveld, Jennifer; Burrows, Heather; Orringer, Kelly
      Abstract: Background: Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports. The rubric used the acronym SAFEST as a reminder to include 6 key elements: 1. Staff involved in the incident. 2. Actual event description. 3. Follow-up initiated. 4. Effect on patient. 5. Standard of care described. 6. To-do/suggestions for improvement.Objectives: This study was designed to determine if the addition of this educational rubric into a standard quality improvement curriculum improves the consistency of information documented in patient safety reports as a subset of a larger quality improvement project aimed at improving safety reporting.Methods: A team of faculty members analyzed individual resident error reports for adherence to the 6 tenets of the SAFEST mnemonic.Results: From April to October of 2014, 2015, and 2016, a convenience sample of 131, 110, and 132 reports, respectively, were extracted and analyzed. For the rates of reporting “staff involved” and “standard of care,” the differences over time were significant, both with P values < 0.001. After training, residents were 2.2 times more likely to report on the “staff involved” in the error and 1.8 times more likely to report the “standard of care.”Discussion: These results describe successful education on a rubric designed to improve the content of patient safety reports.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online November 8, 2017Disclosure: The authors have no financial interest to declare in relation to the content of this article.To Cite: Keefer P, Helms L, Warrier K, Vredeveld J, Burrows H, Orringer K. SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers. Pediatr Qual Saf 2017;2:e045.*Corresponding author. Address: Patricia Keefer, 1540 E Hospital Drive, SPC 4280, Ann Arbor, MI 48109, PH: 734-615-7845; FAX: 734-647-5624, Email: pkeefer@med.umich.eduReceived for publication January 10, 2017; Accepted September 12, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
  • Implementation of an Outcome Measure in Pediatric Behavioral Health: A
           Process Improvement Initiative

    • Authors: Butz; Catherine; Valleru, Jahnavi; Castillo, Anthony; Butter, Eric M.
      Abstract: Introduction: Efforts to monitor outcomes in pediatric behavioral health are becoming a quality, financial, and regulatory imperative. The implementation of a broad-based measure to assess patient functioning at the start of pediatric psychology services, as well as at subsequent visits, has not been demonstrated. This article describes the systematic implementation of a measure of health-related quality of life (HRQOL) to assess functional impairment across an entire clinic population using quality improvement science and methodologies.Methods: The Pediatric Quality of Life Inventory Generic Core 4.0 (PedsQL) was administered at initial and subsequent visits for all patients seeking treatment at a large, tertiary care pediatric psychology clinic in an academic pediatric medical center (Nationwide Children’s Hospital, Columbus, Ohio). The goal of this project was to design a process change to support a 90% completion rate of this measurement tool by all clinicians.Results: Within 16 months, the completion rate of the PedsQL increased from a baseline of 39% to the identified goal of 90%. This process change was within control limits (over 80%) for over 12 months.Conclusion: This study demonstrates the implementation of a systematic process for collection of outcome measures in a pediatric behavioral health care setting. Successful administration of an outcome measure at multiple time points during the care of children and adolescents in a large psychology clinic can allow for quantitative assessment of treatment progress and identify a pathway for administration of additional measures.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.Published online October 20, 2017To Cite: Butz C, Valleru J, Castillo A, Butter EM. Implementation of an Outcome Measure in Pediatric Behavioral Health: A Process Improvement Initiative. Pediatr Qual Saf 2017;2:e043.*Corresponding author. Address: Catherine Butz, PhD, Division of Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205 PH: 614-722-4700; FAX: 614-722-4718, Email: Catherine.Butz@nationwidechildrens.orgReceived for publication February 24, 2017; Accepted August 29, 2017.Copyright © 2018 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Fri, 05 Jan 2018 00:00:00 GMT-
       
 
 
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