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Hoyler M, Niederman MS, Girardi NI. What every intensivist should know about..Patient safety huddles in the ICU. J Crit Care 2024; 82:154788. [PMID: 38553353 DOI: 10.1016/j.jcrc.2024.154788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 06/01/2024]
Abstract
Patient safety huddles are brief, multidisciplinary conversations that focus on a specific topic or event. Huddles have been shown to improve communication among healthcare providers in a variety of settings, including the intensive care unit (ICU). This paper presents key features of patient safety huddles and describes the ways in which huddle techniques may be particularly relevant to the practice of critical care.
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Affiliation(s)
- Margo Hoyler
- Division of Critical Care Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Natalia Ivascu Girardi
- Division of Critical Care Medicine, Department of Anesthesiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
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Müller BS, Lüttel D, Schütze D, Blazejewski T, Pommée M, Müller H, Rubin K, Thomeczek C, Schadewitz R, Heuzeroth R, Schwappach D, Güthlin C, Paulitsch M, Gerlach FM. Supporting Error Management and Safety Climate in Ambulatory Care Practices: The CIRSforte Study. J Patient Saf 2024; 20:314-322. [PMID: 38489154 DOI: 10.1097/pts.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND To improve patient safety, it is important that healthcare facilities learn from critical incidents. Tools such as reporting and learning systems and team meetings structure error management and promote learning from incidents. To enhance error management in ambulatory care practices, it is important to promote a climate of safety and ensure personnel share views on safety policies and procedures. In contrast to the hospital sector, little research has been dedicated to developing feasible approaches to supporting error management and safety climate in ambulatory care. In this study, we developed, implemented, and evaluated a multicomponent intervention to address how error management and safety climate can be improved in ambulatory care practices. METHODS In a prospective 1-group pretest-posttest implementation study, we sought to encourage teams in German ambulatory practices to use proven methods such as guidelines, workshops, e-learning, (online) meetings, and e-mail newsletters. A pretest-posttest questionnaire was used to evaluate level and strength of safety climate and psychological behavioral determinants for systematic error management. Using 3 short surveys, we also assessed the state of error management in the participating practices. In semistructured interviews, we asked participants for their views on our intervention measures. RESULTS Overall, 184 ambulatory care practices nationwide agreed to participate. Level of safety climate and safety climate strength (rwg) improved significantly. Of psychological behavioral determinants, significant improvements could be seen in "action/coping planning" and "action control." Seventy-six percent of practices implemented a new reporting and learning system or modified their existing system. The exchange of information between practices also increased over time. Interviews showed that the introductory workshop and provided materials such as report forms or instructions for team meetings were regarded as helpful. CONCLUSIONS A significant improvement in safety climate level and strength, as well as participants' knowledge of how to analyze critical incidents, derive preventive measures and develop concrete plans suggest that it is important to train practice teams, to provide practical tips and tools, and to facilitate the exchange of information between practices. Future randomized and controlled intervention trials should confirm the effectiveness of our multicomponent intervention.Trial registration: Retrospectively registered on 18. November 2019 in German Clinical Trials Register No. DRKS00019053.
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Affiliation(s)
| | | | - Dania Schütze
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Tatjana Blazejewski
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | | | | | | | | | | | | | - David Schwappach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Michael Paulitsch
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main
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3
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Halm MA. A Daily Dose of Communication to Improve Quality and Safety Outcomes. Am J Crit Care 2024; 33:305-310. [PMID: 38945817 DOI: 10.4037/ajcc2024318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Affiliation(s)
- Margo A Halm
- Margo A. Halm is a nurse scientist consultant in Portland, Oregon
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O'Malley T, Capone J, Perla B, Vasbinder S. Let's Talk Safety - Data from the Neonatal Intensive Care Unit Safety and Bed Capacity Huddles. Adv Neonatal Care 2024:00149525-990000000-00129. [PMID: 38907696 DOI: 10.1097/anc.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND Huddles are brief team meetings designed to communicate essential information. Safety huddles provide a forum to identify and review patient safety events. In a just culture, everyone is accountable for patient safety. PURPOSE The purpose of this project is to discuss safety issues/events at the twice daily bed capacity huddles in a Level IV Neonatal Intensive Care Unit (NICU) utilizing a just culture model. Having daily discussions of patient safety and the escalation process for follow-up promotes a just culture. The aims are to improve the unit's culture of safety and learn from patient safety issues. METHODS A just culture model was adopted to promote discussion of safety events during the huddles. A structured checklist of safety events was utilized along with a script of ground rules. Twice a day, a multidisciplinary group gathers to huddle. Nurse leaders facilitate the discussion, track the results, and provide follow-up. RESULTS The structured safety huddle began in May of 2020 and continues twice daily. All required staff attend. The escalation process is defined and has prevented recurrence of some safety issues. The NICU experienced a 14% increase in favorable results on the Agency for Healthcare Research and Quality (AHRQ) culture of safety survey since the inception of the structured safety huddles. IMPLICATIONS FOR PRACTICE AND RESEARCH Safety huddle discussions have impacted the culture of safety on this unit. Tracking of discussions can help to identify trends, improve processes, and impact patient safety.
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Affiliation(s)
- Teresa O'Malley
- Author Affiliations: University of Pittsburgh Medical Center Children's Hospital of Pittsburgh , Pittsburgh, Pennsylvania
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McVey L, Alvarado N, Healey F, Montague J, Todd C, Zaman H, Dowding D, Lynch A, Issa B, Randell R. Talking about falls: a qualitative exploration of spoken communication of patients' fall risks in hospitals and implications for multifactorial approaches to fall prevention. BMJ Qual Saf 2024; 33:166-172. [PMID: 37940414 DOI: 10.1136/bmjqs-2023-016481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Inpatient falls are the most common safety incident reported by hospitals worldwide. Traditionally, responses have been guided by categorising patients' levels of fall risk, but multifactorial approaches are now recommended. These target individual, modifiable fall risk factors, requiring clear communication between multidisciplinary team members. Spoken communication is an important channel, but little is known about its form in this context. We aim to address this by exploring spoken communication between hospital staff about fall prevention and how this supports multifactorial fall prevention practice. METHODS Data were collected through semistructured qualitative interviews with 50 staff and ethnographic observations of fall prevention practices (251.25 hours) on orthopaedic and older person wards in four English hospitals. Findings were analysed using a framework approach. FINDINGS We observed staff engaging in 'multifactorial talk' to address patients' modifiable risk factors, especially during multidisciplinary meetings which were patient focused rather than risk type focused. Such communication coexisted with 'categorisation talk', which focused on patients' levels of fall risk and allocating nursing supervision to 'high risk' patients. Staff negotiated tensions between these different approaches through frequent 'hybrid talk', where, as well as categorising risks, they also discussed how to modify them. CONCLUSION To support hospitals in implementing multifactorial, multidisciplinary fall prevention, we recommend: (1) focusing on patients' individual risk factors and actions to address them (a 'why?' rather than a 'who' approach); (2) where not possible to avoid 'high risk' categorisations, employing 'hybrid' communication which emphasises actions to modify individual risk factors, as well as risk level; (3) challenging assumptions about generic interventions to identify what individual patients need; and (4) timing meetings to enable staff from different disciplines to participate.
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Affiliation(s)
- Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | | | - Frances Healey
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Jane Montague
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Hadar Zaman
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Alison Lynch
- Manchester Clinical Academic Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Basma Issa
- Patient/public author, University of Bradford, Bradford, UK
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
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Świtalski J, Radomska A, Tatara T, Wnuk K, Miazga W, Szpakowski R, Borowska M, Zdęba-Mozoła A, Kozłowski R, Marczak M, Czerw A, Dykowska G. Teamwork and safety climate in Polish long-term care facilities: questionnaire reliability and usability. Sci Rep 2023; 13:21115. [PMID: 38036634 PMCID: PMC10689842 DOI: 10.1038/s41598-023-48415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023] Open
Abstract
The Teamwork and Safety Climate Survey (TSCS) is one of the questionnaires used to measure patient safety. The questionnaire includes two scales: teamwork climate and safety climate. The objective of the study is the linguistic and cultural adaptation of the TSCS to Polish conditions and checking the reliability and usability of the tool in long-term care facilities. Firstly, the TSCS was translated into Polish. Then, a cross-sectional survey was conducted among the medical and auxiliary personnel of long-term care facilities all over Poland. The psychometric properties of the questionnaire were analysed (including Cronbach's alpha coefficient). Correlations between the areas of the questionnaire and individual variables relating to facility parameters were also calculated. Respondents (n = 558) working in 26 different long-term care facilities participated in the study. The analysis has provided four scales instead of two of the original version of the questionnaire (teamwork climate, safety climate, ability to speak up and following the rules, work organisation). Correlation analysis revealed a number of significant correlations between the scales and individual variables corresponding to the parameters of long-term care facilities and respondents themselves. In conclusion, the Polish version of the TSCS may be a useful tool to measure aspects related to patient safety culture in long-term care facilities.
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Affiliation(s)
- Jakub Świtalski
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, ul. Erazma Ciołka 27, 01-445, Warszawa, Poland.
| | - Agnieszka Radomska
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, ul. Erazma Ciołka 27, 01-445, Warszawa, Poland
| | - Tomasz Tatara
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Katarzyna Wnuk
- Department of Health Policy Programs, Faculty of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00-032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-826, Warsaw, Poland
| | - Wojciech Miazga
- Department of Health Policy Programs, Faculty of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00-032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-826, Warsaw, Poland
| | - Rafał Szpakowski
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, 01-445, Warsaw, Poland
| | - Mariola Borowska
- Department of Cancer Epidemiology and Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Agnieszka Zdęba-Mozoła
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131, Lodz, Poland
| | - Remigiusz Kozłowski
- Center for Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237, Lodz, Poland
| | - Michał Marczak
- Collegium Management, WSB Merito University in Warsaw, 03-204, Warszawa, Poland
| | - Aleksandra Czerw
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, ul. Erazma Ciołka 27, 01-445, Warszawa, Poland
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791, Warsaw, Poland
| | - Grażyna Dykowska
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, ul. Erazma Ciołka 27, 01-445, Warszawa, Poland
- Warsaw College of Engineering and Health, 02-366, Warsaw, Poland
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Williams C. 'Corridor care' in the emergency department: managing patient care in non-clinical areas safely and efficiently. Emerg Nurse 2023; 31:34-41. [PMID: 37818625 DOI: 10.7748/en.2023.e2187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/12/2023]
Abstract
Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end - or at least reduce - corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs.
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Britton H. Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project. BMJ Open Qual 2023; 12:e002405. [PMID: 37793675 PMCID: PMC10551953 DOI: 10.1136/bmjoq-2023-002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND NHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward. INTERVENTION Thirty-minute board rounds were reduced from twice daily (Monday-Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5-10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation. METHODS This QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process'. Patient discharge data were collated via trust metrics as a balancing measure. RESULTS Through board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75-17.5 confirming no negative impact on patient flow following board round amendments. CONCLUSION While significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.
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Affiliation(s)
- Hannah Britton
- Care of the elderly medicine, North Bristol NHS Trust, Westbury on Trym, UK
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Rodríguez-Fernández R, Sánchez-Barriopedro L, Merino-Hernández A, González-Sánchez MI, Pérez-Moreno J, Toledo Del Castillo B, González Martínez F, Díaz de Mera Aranda C, Eizaguirre Fernández-Palacios T, Dominguez Rodríguez A, Tierraseca Serrano E, Sánchez Jiménez M, Sanchez Lloreda O, Carballo Nuria M. [Impact of the "daily huddle" on the safety of pediatric hospitalized patients]. J Healthc Qual Res 2023; 38:268-276. [PMID: 37003929 DOI: 10.1016/j.jhqr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/05/2023] [Accepted: 03/06/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.
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Affiliation(s)
- R Rodríguez-Fernández
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España.
| | | | - A Merino-Hernández
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - M I González-Sánchez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - J Pérez-Moreno
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - B Toledo Del Castillo
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | - F González Martínez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, España
| | | | | | | | | | - M Sánchez Jiménez
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - O Sanchez Lloreda
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
| | - M Carballo Nuria
- Servicio de Pediatría, Hospital Infantil Gregorio Marañón, Madrid, España
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Perkowski C, Eldridge B, Zurca AD, Demartini TKM, Ceneviva GD, Williams D, Fang X, Zhou S, Thomas NJ, Krawiec C. Impact of Pediatric Intensive Care Unit Preadmission Huddle on Perceptions of Interprofessional Communication About Patient Safety. Crit Care Nurse 2022; 42:55-67. [PMID: 35908765 DOI: 10.4037/ccn2022307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Preadmission discussions in the study institution's pediatric intensive care unit are not standardized and admission plans were thought to be disjointed, leading to a perceived lack of organization and preparation for the arrival of a critically ill child. OBJECTIVE To evaluate the impact of a new, formalized preadmission pediatric intensive care unit interdisciplinary huddle on clinician perceptions of interprofessional communication. The hypothesis was that preadmission huddles would improve unit clinicians' perceptions of interprofessional communication. METHODS Interprofessional pediatric intensive care unit clinicians (physicians, advanced practice providers, nurses, and respiratory therapists) completed surveys before and 7 months after preadmission interdisciplinary huddle implementation. Huddle compliance and perceptions of interprofessional communication in the unit were evaluated. RESULTS Of 265 eligible pediatric intensive care unit admissions, 69 huddles (26.0%) occurred. The postintervention survey revealed increased odds (odds ratio [95% CI]) of responding "strongly agree" or "agree" to questions about the opportunity to "communicate effectively with health care team members" (2.42 [1.10-5.34]), "respond to feedback from health care team members" (2.54 [1.23-5.24]), and "convey knowledge to other health care team members" (2.71 [1.31-5.61]) before an admission. DISCUSSION This study introduced a formalized huddle that improved pediatric intensive care unit clinicians' perceived communication with other health care team members in the preadmission period. CONCLUSIONS Future studies are needed to determine if this perceived improvement in communication significantly affects health care outcomes of critically ill children or if these results are generalizable to other pediatric intensive care unit settings.
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Affiliation(s)
- Caroline Perkowski
- Caroline Perkowski was a pediatric intensive care unit fellow, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, at the time the study was conducted
| | - Barbara Eldridge
- Barbara Eldridge is a critical care nurse in the pediatric intensive care unit, Department of Nursing, Penn State Health Children's Hospital
| | - Adrian D Zurca
- Adrian D. Zurca is a pediatric intensivist and pediatric critical care fellowship director, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Theodore K M Demartini
- Theodore K. M. Demartini is a pediatric intensivist and medical director of quality and safety, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Gary D Ceneviva
- Gary D. Ceneviva is a pediatric intensivist, Division Chief, and Vice Chair of Clinical Affairs, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital
| | - Duane Williams
- Duane Williams is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and the Medical Director of patient throughput at Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Xinying Fang
- Xinying Fang is a graduate research assistant of statistics, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Shouhao Zhou
- Shouhao Zhou is a biostatistician, Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine
| | - Neal J Thomas
- Neal J. Thomas is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and Associate Dean for clinical research at Pennsylvania State University College of Medicine
| | - Conrad Krawiec
- Conrad Krawiec is a pediatric intensivist, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, and Pediatric Clerkship Director at Pennsylvania State University College of Medicine
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