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Pangonis SF, Schaffzin JK, Claes D, Mortenson JE, Nehus E. An initiative to improve effluent culture detection among pediatric patients undergoing peritoneal dialysis through process improvement. Pediatr Nephrol 2023; 38:211-218. [PMID: 35445978 PMCID: PMC9021362 DOI: 10.1007/s00467-022-05533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Peritonitis is a significant cause of morbidity and healthcare cost among pediatric patients undergoing peritoneal dialysis. Culture-negative peritonitis has been associated with an increased risk of technique failure. Known risk factors for culture-negative peritonitis are related to the process of collection and sample processing for culture, but additional studies are needed. A culture detection rate of 16.7% was identified among our patients undergoing peritoneal dialysis, which is below the national benchmark of ≥ 85%. Our primary objective of this quality improvement project was to improve culture detection rates. METHODS Interventions were developed aimed at standardizing the process of effluent collection and laboratory processing, timely collection and processing of samples, and addressing other modifying risk factors for lack of bacterial growth from culture. These interventions included direct inoculation of effluent into blood culture bottles at bedside and use of an automated blood culture system. Two Plan-Do-Study-Act cycles were completed prior to moving to the sustain phase. RESULTS The culture detection rate improved from 16.7% (pre-intervention) to 100% (post-intervention). A decrease in the median process time also occurred from 83 min (pre-intervention) to 53 min (post-intervention). An individual and moving range chart identified a decrease in both the centerline (mean) and upper control limit, indicating that the process became more reliable during the sustain phase. CONCLUSIONS An improvement in process time and culture positivity rate occurred following standardization of our PD fluid culture process. Future studies should be aimed at the impact of the components of collection and processing methods on the effluent culture yield. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Scott F. Pangonis
- Department of Pediatrics, Children’s Medical Center of Akron, Akron, OH 44308 USA
| | - Joshua K. Schaffzin
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Donna Claes
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Joel E. Mortenson
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Edward Nehus
- grid.36425.360000 0001 2216 9681Department of Pediatrics, Marshall University Joan C Edwards School of Medicine, Huntington, WV 25701 USA
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Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events. Pediatr Qual Saf 2021; 6:e495. [PMID: 34934878 PMCID: PMC8677994 DOI: 10.1097/pq9.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. The perioperative environment is one of the most complex areas within a hospital with significant safety risks. Despite a long history of safety-focused work, a recent cluster of patient safety events prompted a renewed comprehensive approach to improve safety processes and transform culture.
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Applying Lessons from an Inaugural Clinical Pathway to Establish a Clinical Effectiveness Program. Pediatr Qual Saf 2018; 3:e115. [PMID: 31334447 PMCID: PMC6581477 DOI: 10.1097/pq9.0000000000000115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/19/2018] [Indexed: 01/22/2023] Open
Abstract
Introduction: Clinical effectiveness (CE) programs promote standardization to reduce unnecessary variation and improve healthcare value. Best practices for successful and sustainable CE programs remain in question. We developed and implemented our inaugural clinical pathway with the aim of incorporating lessons learned in the build of a CE program at our academic children’s hospital. Methods: The Lucile Packard Children’s Hospital Stanford Heart Center and Center for Quality and Clinical Effectiveness partnered to develop and implement an inaugural clinical pathway. Project phases included team assembly, pathway development, implementation, monitoring and evaluation, and improvement. We ascertained Critical CE program elements by focus group discussion among a multidisciplinary panel of experts and key affected groups. Pre and postintervention compared outcomes included mechanical ventilation duration, cardiovascular intensive care unit, and total postoperative length of stay. Results: Twenty-seven of the 30 enrolled patients (90%) completed the pathway. There was a reduction in ventilator days (mean 1.0 + 0.5 versus 1.9 + 1.3 days; P < 0.001), cardiovascular intensive care unit (mean 2.3 + 1.1 versus 4.6 + 2.1 days; P < 0.001) and postoperative length of stay (mean 5.9 + 1.6 versus 7.9 + 2.7 days; P < 0.001) compared with the preintervention period. Elements deemed critical included (1) project prioritization for maximal return on investment; (2) multidisciplinary involvement; (3) pathway focus on best practices, critical outcomes, and rate-limiting steps; (4) active and flexible implementation; and (5) continuous data-driven and transparent pathway iteration. Conclusions: We identified multiple elements of successful pathway implementation, that we believe to be critical foundational elements of our CE program.
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Schaffzin JK, Simon K, Connelly BL, Mangano FT. Standardizing preoperative preparation to reduce surgical site infections among pediatric neurosurgical patients. J Neurosurg Pediatr 2017; 19:399-406. [PMID: 28128706 DOI: 10.3171/2016.10.peds16287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are costly to patients and the health care system. Pediatric neurosurgery SSI risk factors are not well defined. Intraoperative protocols have reduced, but have not eliminated, SSIs. The effect of preoperative intervention is unknown. Using quality improvement methods, a preoperative SSI prevention protocol for pediatric neurosurgical patients was implemented to assess its effect on SSI rate. METHODS Patients who underwent a scheduled neurosurgical procedure between January 2014 and December 2015 were included. Published evidence and provider consensus were used to guide preoperative protocol development. The Model for Improvement was used to test interventions. Intraoperative and postoperative management was not standardized or modified systematically. Staff, family, and overall adherence was measured as all-or-nothing. In addition, SSI rates among eligible procedures were measured before and after protocol implementation. RESULTS Within 4 months, overall protocol adherence increased from 51.3% to a sustained 85.7%. SSI rates decreased from 2.9 per 100 procedures preintervention to 0.62 infections postintervention (p = 0.003). An approximate 79% reduction in SSI risk was identified (risk ratio 0.21, 95% CI 0.08-0.56; p = 0.001). CONCLUSIONS Clinical staff and families successfully collaborated on a standardized preoperative protocol for pediatric neurosurgical patients. Standardization of the preoperative phase of care alone reduced SSI rates. Attention to the preoperative in addition to the intraoperative and postoperative phases of care may lead to further reduction in SSI rates.
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Affiliation(s)
| | | | | | - Francesco T. Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Lail J, Schoettker PJ, White DL, Mehta B, Kotagal UR. Applying the Chronic Care Model to Improve Care and Outcomes at a Pediatric Medical Center. Jt Comm J Qual Patient Saf 2017; 43:101-112. [PMID: 28334588 DOI: 10.1016/j.jcjq.2016.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cincinnati Children's Hospital Medical Center launched the Condition Outcomes Improvement Initiative in 2012 to help disease-based teams use the principles of improvement science to implement components of the Chronic Care Model and improve outpatient care delivery for populations of children with chronic and complex conditions. The goal was to improve outcomes by 20% from baseline. METHODS Initiative activities included review of the evidence to choose and measure outcomes, development of condition-specific patient registries and tools for data collection, patient stratification, planning and coordinating care before and after visits, and self-management support. RESULTS Eighteen condition teams, in sequenced cohorts, fully participated in the three-year initiative. As of October 1, 2015, data from 27,221 active patients with chronic conditions were entered into registries within the electronic health record and being used to inform quality improvement and population management. Overall, 13,601 of these children had an improved outcome. Seven of the teams had implemented their evidence-based interventions with ≥ 90% reliability, 83% of teams were regularly using an electronic template to plan care for a child's condition before an encounter, 89% had stratified their population by severity of medical/psychosocial needs, 56% were using registry care gap data for population management, and 72% were doing self-management assessments. Eleven teams achieved the numeric goal of 20% improvement in their chosen outcome. CONCLUSION The results suggest that, by implementing quality improvement methods with multidisciplinary support, clinical teams can manage chronic condition populations and improve clinical, functional, and patient-reported outcomes. This work continues to be spread across the institution.
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Affiliation(s)
- Julie Reed
- Deputy Director and Academic Lead, National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care Northwest London (NIHR CLAHRC NWL), Imperial College, London, UK
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Brady PW, Zix J, Brilli R, Wheeler DS, Griffith K, Giaccone MJ, Dressman K, Kotagal U, Muething S, Tegtmeyer K. Developing and evaluating the success of a family activated medical emergency team: a quality improvement report. BMJ Qual Saf 2014; 24:203-11. [PMID: 25516987 DOI: 10.1136/bmjqs-2014-003001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU). METHODS The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of family-activated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls. RESULTS Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, p<0.001). Families, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons. CONCLUSIONS Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children.
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Affiliation(s)
- Patrick W Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julie Zix
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Richard Brilli
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Derek S Wheeler
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kristie Griffith
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Jo Giaccone
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathy Dressman
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Uma Kotagal
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephen Muething
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ken Tegtmeyer
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Philibert I, Gonzalez Del Rey JA, Lannon C, Lieh-Lai M, Weiss KB. Quality improvement skills for pediatric residents: from lecture to implementation and sustainability. Acad Pediatr 2014; 14:40-6. [PMID: 24369868 DOI: 10.1016/j.acap.2013.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/13/2013] [Accepted: 03/27/2013] [Indexed: 12/30/2022]
Abstract
Quality improvement (QI) skills are relevant to efforts to improve the health care system. The Accreditation Council for Graduate Medical Education (ACGME) program requirements call for resident participation in local and institutional QI efforts, and the move to outcomes-based accreditation is resulting in greater focus on the resulting learning and clinical outcomes. Many programs have enhanced practice-based learning and improvement (PBLI) and systems based practice (SBP) curricula, although efforts to actively involve residents in QI activities appear to be lagging. Using information from the extensive experience of Cincinnati Children's Hospital Medical Center, we offer recommendations for how to create meaningful QI experiences for residents meet ACGME requirements and the expectations of the Clinical Learning Environment Review (CLER) process. Resident involvement in QI requires a multipronged approach that overcomes barriers and limitations that have frustrated earlier efforts to move this education from lectures to immersion experiences at the bedside and in the clinic. We present 5 dimensions of effective programs that facilitate active resident participation in improvement work and enhance their QI skills: 1) providing curricula and education models that ground residents in QI principles; 2) ensuring faculty development to prepare physicians for their role in teaching QI and demonstrating it in day-to-day practice; 3) ensuring all residents receive meaningful QI education and practical exposure to improvement projects; 4) overcoming time and other constraints to allow residents to apply their newly developed QI skills; and 5) assessing the effect of exposure to QI on resident competence and project outcomes.
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Affiliation(s)
- Ingrid Philibert
- Accreditation Council for Graduate Medical Education, Chicago, Ill.
| | | | - Carole Lannon
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Mary Lieh-Lai
- Accreditation Council for Graduate Medical Education, Chicago, Ill; Wayne State University, Detroit, Michigan
| | - Kevin B Weiss
- Accreditation Council for Graduate Medical Education, Chicago, Ill
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A comprehensive model to build improvement capability in a pediatric academic medical center. Acad Pediatr 2014; 14:29-39. [PMID: 24369867 DOI: 10.1016/j.acap.2013.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/18/2013] [Accepted: 02/17/2013] [Indexed: 11/21/2022]
Abstract
Cincinnati Children's Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I(2)S(2)) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children's Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC's strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.
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Pratap JN, Varughese AM, Kurth CD, Adler E. Getting started with the model for improvement: introduction and understanding variation. Br J Hosp Med (Lond) 2013; 73:701-5. [PMID: 23502200 DOI: 10.12968/hmed.2012.73.12.701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Nick Pratap
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Tofani BF, Rineair SA, Gosdin CH, Pilcher PM, McGee S, Varadarajan KR, Schoettker PJ. Quality improvement project to reduce infiltration and extravasation events in a pediatric hospital. J Pediatr Nurs 2012; 27:682-9. [PMID: 22342260 DOI: 10.1016/j.pedn.2012.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/05/2012] [Accepted: 01/15/2012] [Indexed: 11/19/2022]
Abstract
A safety event response team at Cincinnati Children's Hospital Medical Center developed and tested improvement strategies to reduce peripheral intravenous (PIV) infiltration and extravasation injuries. Improvement activities included development of the touch-look-compare method for hourly PIV site assessment, staff education and mandatory demonstration of PIV site assessment, and performance monitoring and sharing of compliance results. We observed a significant reduction in the injury rate immediately following implementation of the interventions that corresponded with monitoring compliance in performing hourly assessments on patients with a PIV, but this was not sustained. The team is currently examining other strategies to reduce PIV injuries.
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Affiliation(s)
- Barbara F Tofani
- Perioperative Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Muething SE, Goudie A, Schoettker PJ, Donnelly LF, Goodfriend MA, Bracke TM, Brady PW, Wheeler DS, Anderson JM, Kotagal UR. Quality improvement initiative to reduce serious safety events and improve patient safety culture. Pediatrics 2012; 130:e423-31. [PMID: 22802607 PMCID: PMC3408689 DOI: 10.1542/peds.2011-3566] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. METHODS A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture. RESULTS SSEs per 10000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P < .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P < .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. CONCLUSIONS Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions.
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Affiliation(s)
- Stephen E. Muething
- Divisions of General and Community Pediatrics,,James M. Anderson Center for Health Systems Excellence
| | | | | | | | | | | | - Patrick W. Brady
- Divisions of General and Community Pediatrics,,James M. Anderson Center for Health Systems Excellence
| | | | - James M. Anderson
- Advisor to the President and CEO, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Britto MT. Society for Pediatric Research Presidential Address 2011: improving child health outcomes--from 65 roses to high reliability. Pediatr Res 2012; 71:311-4. [PMID: 22337261 DOI: 10.1038/pr.2011.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maria T Britto
- Division of Adolescent Medicine, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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A Two-Pronged Quality Improvement Training Program for Leaders and Frontline Staff. Jt Comm J Qual Patient Saf 2011; 37:147-53. [DOI: 10.1016/s1553-7250(11)37018-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Journey to No Preventable Risk: The Baylor Health Care System Patient Safety Experience. Am J Med Qual 2010; 26:43-52. [DOI: 10.1177/1062860610374645] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mandel KE, Muething SE, Schoettker PJ, Kotagal UR. Transforming safety and effectiveness in pediatric hospital care locally and nationally. Pediatr Clin North Am 2009; 56:905-18. [PMID: 19660634 DOI: 10.1016/j.pcl.2009.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving dramatic, sustainable improvements in the safety and effectiveness of care for children requires a transformational approach to how hospitals individually focus on improvement and learn from each other to achieve national goals. The authors describe a theoretic framework for transformation that includes setting system-level priorities, aligning measures with each priority, identifying breakthrough targets, testing interventions to get results, and spreading successful interventions throughout the organization. Essential key drivers of transformation include leadership, building will, transparency, a business case for quality, patient and family engagement, improvement infrastructure, improvement capability, and reliability and standardization. Improving national system-level measures requires each hospital to pursue its own transformation journey while collaborating with hospitals and other organizations.
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Affiliation(s)
- Keith E Mandel
- Physician-Hospital Organization, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Mail Location 7023, Cincinnati, OH 45229, USA.
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Britto MT, Schoettker PJ, Pandzik GM, Weiland J, Mandel KE. Improving influenza immunisation for high-risk children and adolescents. Qual Saf Health Care 2007; 16:363-8. [PMID: 17913778 PMCID: PMC2464966 DOI: 10.1136/qshc.2006.019380] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To improve influenza vaccination rates for high-risk children and adolescents. METHODS During the 2004-5 influenza season, 5 regional cystic fibrosis (CF) centres, 6 hospital clinics that participated in a similar initiative the previous year, 4 new hospital clinics, and 39 community-based paediatric practices implemented a multicomponent change package consisting of nine improvement strategies designed to increase immunisation of high-risk patients. Each site was encouraged to adopt and customize the improvement strategies to meet their specific culture and needs. The main outcome measure was the proportion of the target population immunised. Surveys sent to the community practices were summarised. RESULTS The intervention targeted a total of 18 866 high-risk children and 9374 (49.7%) received the influenza vaccination. Community-based practices that actively participated in the collaborative reported using significantly more intervention strategies (mean (SD) 7.4 (2.3) vs 4.6 (1.5), respectively, p = 0.001) and achieved higher immunisation rates (59.3% (13.6%) vs 43.7% (20.5%), respectively, p = 0.01) than non-participating practices. The most frequently implemented change concepts were posters in the office, walk-in clinics or same-day appointments and reminder phone calls. The interventions deemed most helpful were weekend or evening "flu shot only" sessions, walk-in or same-day appointments, reminder calls and special mailings to families. CONCLUSIONS Implementation of the change package, based on evidence and diffusion of innovation theory, resulted in higher immunisation rates than typically reported in the medical literature, especially for the community-based primary care practices.
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Affiliation(s)
- Maria T Britto
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3039, USA.
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Gerhardt WE, Schoettker PJ, Donovan EF, Kotagal UR, Muething SE. Putting evidence-based clinical practice guidelines into practice: an academic pediatric center's experience. Jt Comm J Qual Patient Saf 2007; 33:226-35. [PMID: 17441561 DOI: 10.1016/s1553-7250(07)33027-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical practice guidelines can provide a much-needed interface between research and practice, pointing the way to higher quality, evidence-based, and more cost-effective care. Cincinnati Children's Hospital Medical Center developed a formal process for the production of 29 evidence-based guidelines and companion tools. COMPONENTS OF DEVELOPMENT AND IMPLEMENTATION Clinical practice guidelines and their companion documents are developed by interprofessional teams that are led by community physicians and that include hospital-based physicians, nurses, other allied health professionals, and patients or parents. An education coordinator develops an education plan that outlines specific clinical practice changes and expected outcomes to be monitored. Guideline evidence is embedded into companion documents and processes available at the point of care. Electronic order sets for treatments and medications have been developed using available guidelines as sources of evidence. All guideline-based order sets include an automatic order for use of the associated clinical pathway. It is important to create and maintain an evidence-based environment in an academic medical center. CONCLUSIONS Keys to success include a rigorous methodology, tools that place the evidence in the hands of providers at the site of care, feedback on outcomes, and an environment that encourages evidence-based care.
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Affiliation(s)
- Wendy E Gerhardt
- Center for Professional Excellence, Cincinnati Children's Hospital Medical Center, USA.
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