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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  [289 journals]
  • Noncompliance to a Postoperative Algorithm Using Feeding Readiness
           Assessments Prolonged Length of Stay at a Pediatric Heart Institute.

    • Authors: Ehrmann; Daniel E.; Harendt, Shaunda; Church, Jessica; Stimmler, Amy; Vichayavilas, Piyagarnt; Batz, Sanja; Rodgers, Jennifer; DiMaria, Michael; Barrett, Cindy; Kaufman, Jon
      Abstract: Introduction: Variable compliance to postoperative feeding algorithms after pediatric cardiac surgery may be associated with suboptimal growth, decreased parental satisfaction, and prolonged hospital length of stay (LOS). Our heart center performed an audit of compliance to a previously introduced postoperative feeding algorithm to guide quality improvement efforts. We hypothesized that algorithm noncompliance would be associated with increased LOS.Methods: We retrospectively identified children
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Integrating a Geneticist in a Multidisciplinary Clinic for Down Syndrome
           Increases Commitment to Genetic Counseling.

    • Authors: Santoro; Stephanie L.; Jacobson, Theodora; Lemle, Stephanie; Bartman, Thomas
      Abstract: Background: Although most physicians and genetic professionals are familiar with Down syndrome, many families do not have experience with Down syndrome before having a child diagnosed. The American Academy of Pediatrics has specific recommendations for genetic counseling and chromosome analysis for Down syndrome.Local Problem: The literature indicates that adherence to completion of appropriately timed genetic counseling is low at 31%. This study was initiated to determine our adherence rates and to improve if needed.Methods: In the Down syndrome clinic at Nationwide Children's Hospital, a subspecialty clinic in the Division of Developmental and Behavioral Pediatrics, a genetic counselor was on-call but did not routinely attend. The intervention consisted of multidisciplinary care with the presence of a clinical geneticist. Statistical Process Control Charts and Fisher's exact test were used to determine the impact of the intervention.Results: Our baseline rate of adherence to genetic counseling was similar to previous publications. Direct genetics involvement in the Down syndrome clinic in place of an on-call genetic counselor led to significant improvement in adherence to genetic counseling recommendations over a 6-month period from 35% to 62%, P < 0.001 and sustained for 6 months. Postclinic adherence rates and subanalyses by age showed similar results. The final postvisit adherence rate of 89% in February 2017 demonstrates continued improvement. Geneticist involvement allowed chromosome reports uploading and karyotype listing in electronic medical records.Implications and Lessons Learned: Genetic counseling in newborns with Down syndrome is important, yet was often not received at Nationwide Children's Hospital before this study. Integrating a geneticist resulted in improvement. Implementing similar models at other institutions can ensure that the correct genetic testing is completed, results documented and families counseled appropriately.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. The work cannot be changed in any way or used commercially without permission from the journal.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Improving Inpatient Asthma Management: The Implementation and Evaluation
           of a Pediatric Asthma Clinical Pathway.

    • Authors: Magruder; Teresa G.; Narayanan, Sridaran; Walley, Susan; Powers, Tony; Whitlock, Hollace; Harrington, Kathleen; Wall, Terry C.
      Abstract: Introduction: Asthma exacerbations are a leading cause of pediatric hospitalizations. Despite national guidelines, variability exists in the use and dosing of bronchodilators, oxygen management, and respiratory assessments of patients. We aimed to implement an inpatient Asthma Clinical Pathway (Pathway) to standardize care and reduce length of stay (LOS).Methods: A respiratory therapy-driven Pathway was designed for inpatient asthma management. The Pathway included standardized respiratory therapy assessments, bronchodilator dosing, and protocols for progression and clinical worsening. We monitored key process measures. Patients admitted to the Pathway during pilot implementation (March to December 2011) were compared retrospectively with a "Usual Care" cohort admitted during the same period. We compared average LOS, average billed charges per hospitalization (charges), and 30-day readmissions between groups. Statistical process control charts were utilized to analyze LOS and charges for all asthma admissions following Pathway implementation (March 2011 to September 2016). Readmissions and Pathway removals were balancing measures.Results: During pilot, Pathway patients (n = 153) compared with "Usual Care" patients (n = 166) had shorter LOS (0.95 versus 1.86 days; P < 0.001) and lower charges ($7,413 versus $11,078; P < 0.001). Readmission rates were not significantly different between groups. LOS for all asthma admissions (n = 3,429) decreased from 2.30 to 1.44 days (P < 0.001) following Pathway implementation. Charges remained stable. The readmission rate (per 100 discharges) for all asthma was 2.42 and not significantly different between Pathway and non-Pathway groups.Conclusions: Pathway implementation reduced LOS and stabilized charges while not increasing readmission rates. The Pathway facilitated sustainable widely adopted improvements in asthma care.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.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Utilizing Lean Principles to Improve Immunization Administration
           Efficiency in a Pediatric Mobile Clinic Program.

    • Authors: Gupta; Aditi; Misra, Sanghamitra M.; Garcia, Cassandra; Ugalde, Margaret
      Abstract: Introduction: Mobile clinics are vital health care delivery systems because they provide care to those who may not have access otherwise. Unfortunately, clinic flow on mobile clinics is often chaotic and inherently inefficient. Lean is a customer-centric methodology used in industries like health care to continuously improve processes by eliminating waste. The purpose of this project was to use lean principles to improve efficiency, as measured by total time spent receiving services, so that more underserved patients could receive needed immunizations.Methods: Using a certified lean expert, lean principles were applied to the mobile clinic program to uniformly organize the program, simplify registration processes, and standardize clinic procedures. Time study data were collected prospectively on a total of 309 patients for 2-week periods both before and after application of lean principles. Staff used a standardized time study form to record patient visit times. Pre- and postintervention data were analyzed using unpaired t tests and nonparametric Mann-Whitney tests as deemed appropriate.Results: Using lean principles significantly reduced total times spent for 1-, 2-, and 4-children families. Wait times for 1- and 4-children families were also significantly decreased. Lastly, times spent on board the mobile clinic to receive immunizations for 1- and 3-children families were significantly decreased.Conclusion: Application of lean principles can improve efficiency by decreasing total time spent for patients receiving vaccine services on pediatric mobile clinics.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.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Implementation of the Asthma Control Test in a Large Primary Care Network.

    • Authors: Sangvai; Shilpa; Hersey, Stephen J.; Snyder, Dane A.; Allen, Elizabeth D.; Hafer, Cindy; Wickliffe, Jeanne; Groner, Judith A.
      Abstract: Introduction: Achieving control in asthma is a primary goal of pediatric care, and assessing the degree of control is a principal step in management. The purpose of this quality improvement project was to implement the Asthma Control Test (ACT) and the Childhood Asthma Control Test (C-ACT) in a large primary care network as a means to reliably and consistently assess asthma control at all visit types.Methods: A prospective design was used to measure provider documentation of the ACT or C-ACT. Patients (or caregivers) 4 years of age or older with a known diagnosis of asthma were administered the ACT (ages 12 and older) or the C-ACT (ages, 4-11). The quality improvement project, which involved multiple interventions, took place at 11 centers of the Primary Care Network of Nationwide Children's Hospital from November 2013 to December 2014. A goal was set for a 70% completion rate of the ACT/C-ACT at any visit type for patients 4 years of age or older with asthma.Results: Six months after the introduction of the questionnaires, the 70% completion rate was reached. Rates of ACT/C-ACT completion have consistently exceeded 70% through December 2016.Conclusions: We demonstrated that the ACT/C-ACT can be integrated into a busy primary care network. It is imperative to work toward better asthma care; consistent assessment of asthma control can be the critical first step.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.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Development of Pediatric Emergency Protocols and Communication Plans in
           Pediatric Radiation Oncology: Multidisciplinary Core Competencies.

    • Authors: Carson; Rebecca A.; Ladra, Matthew M.; Choflet, Amanda
      Abstract: Radiation therapy is an essential component of treatment for many pediatric cancers, yet the cost of maintaining a radiation facility at a dedicated pediatric center is often prohibitive. As a result, adult facilities treat pediatric patients where preparation for a pediatric emergency may be inadequate. The purpose of this quality improvement project was to develop a multidisciplinary emergency preparedness plan for a collaborative pediatric radiation oncology program at an adult community hospital with its partnering academic children's hospital. Using a cyclical process involving multidisciplinary collaboration that combines policy development, preparation, and team-building, the authors created the protocols and processes that would support the stabilization of a pediatric emergency and facilitate transfer to the partnering children's hospital. Further development of a communication plan outlines the flow of patient information through the multidisciplinary team during these transitions of care. Areas for future work include quantitative outcome measures to determine the effectiveness of the policies and procedures developed to prepare staff for pediatric emergencies.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.Copyright (C) 2017 The
      Authors . Published by Wolters Kluwer Health, Inc. Health, Inc. All rights reserved.
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
  • Quality in Context: The Role of Social Determinants of Health in Pediatric
           Quality Improvement.

    • Authors: Chisolm; Deena J.
      Abstract: No abstract available
      PubDate: Thu, 28 Sep 2017 00:00:00 GMT-
       
 
 
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