What Patients Say, What Doctors Hear (and Vice Versa): The Highest Stakes in Medicine
Children’s Hospital of Richmond at VCU and Children’s Healthcare of Atlanta share how simple tools and the Safety Coach Program can enhance quality.
Children's Health Children's Medical Center Dallas and Kaiser Foundation Hospital – Roseville, Women’s and Children’s Services describe how CoDesign and the Family Advisor Network partner drive meaningful improvements in the patient care experience.
Rady Children's Hospital San Diego and Children's Hospital Colorado share interventions for reducing unnecessary opioid prescription for pediatric patients.
Arkansas Children's Hospital Northwest and Arkansas Children's Hospital share how Six Sigma method helps improve scheduling and reduce patient wait time.
In less than three years, a clinically integrated network demonstrated improved quality performance across 12 pediatric primary care preventive and chronic condition measures. Children’s Mercy Kansas City achieved increases of 4 to 51 percentage points using data, a common operational framework and process to identify, share, and disseminate best practices. The network drove improvement by collaborating with infectious disease specialists, developing a set of shared resources and best practices, and effectively using data and population health technology.
A nationwide shortage of psychiatry providers combined with high demand for behavioral health services resulted in poor access to behavioral health care. Nationwide Children’s Hospital aimed to reduce the wait times to new patients with behavioral health needs through a series of structured quality improvement efforts.
Hospital acquired conditions are affected by physical spaces, or the built environment. Unintended design flaws may introduce latent safety threats (LSTs) contributing to adverse events. Since LSTs are challenging to identify in the built environment, Children’s Healthcare of Atlanta integrated simulation to identify LSTs inherent to the design of a new outpatient center.
Eight children’s hospitals, including Children’s Hospital at Dartmouth-Hitchcock and Children's Hospital of Wisconsin, are implementing CORE for Kids, the pediatric arm of Project CORE (Coordinating Optimal Referral Experiences). The project aims to promote communication and coordination between primary care providers and specialists. The effort builds upon a CMMI Health Care Innovation Award that demonstrated significant return on investment for academic medical centers.
Cohen Children’s Medical Center redefined a pediatric service-line model to ensure the delivery of high-quality pediatric care throughout a multi-hospital health system. The team used a system quality dashboard, education and spread of standardized care bundles.
Pediatric patients with complex medical needs have suffered poor outcomes in prehospital settings due to under-prepared emergency providers, a lack of accurate information, and delayed access to tertiary care. As a result, patient guardians often lack confidence in emergency medical service and community emergency departments. SSM Health Cardinal Glennon Children’s Hospital developed a program to address the needs of this unique population.
Dell Children's Medical Center of Central Texas integrated mental health care into an acute care facility. Interdisciplinary efforts designed a clinical model that aims to move patients out of the emergency department and better utilize the hospital’s existing consult and liaison services. The service line is building a new electronic medical record platform to optimize care planning.
Medication use remains a common cause of preventable harm across all settings of pediatric care. Pharmacogenomics is an underused strategy that can proactively guide drug selection and dosing. A growing number of pediatric models and resources such as the Clinical Pharmacogenetics Implementation Consortium (CPIC) are now available to help. St. Jude Children’s Research Hospital and Stanford University lead the consortium which develops resources that help, such as creating passive and active clinical decision support. St. Jude has successfully preemptively genotyped more than 4,300 patients.
Children’s Hospital of Philadelphia and Keystone First, a Medicaid managed care organization, initiated a pilot care management program for children with medical complexity. A single children's hospital primary care site provides care for about 15,000 Keystone First patients. Through innovative use of electronic health record tools and a robust quality improvement approach, the hospital achieved reductions in emergency department visits and hospital utilization.
Pediatric Early Warning Score (PEWS) and rapid response team (RRT) expedite interventions needed for timely rescue of a child with clinical deterioration. The Children’s Hospital of Richmond at VCU’s project explains building of PEWS into the electronic medical record, creation and implementation of algorithms to guide the appropriate medical or RRT response to high PEWS scores, and overcoming barriers to implementation.
Workplace violence has become a major safety issue for health care workers. Children’s Hospital Colorado surveyed 3,146 team members on physical and verbal abuse in the workplace. The survey showed that 35.6 percent of respondents had one or more verbal abuse incidents in the past 12 months with 71.6 percent from family or visitors. The hospital responded by developing a workplace violence program.
In 2015, the Riley Hospital for Children at Indiana University Health Heart Center readmission rate for 30 days post discharge was above 12 percent, the length of stay index was 1.2 . Complaints of disjointed transitions of care and poor communication during hospital admissions and prior to discharge from the hospital’s primary care partners and patients was a constant. The hospital created the Nurse Navigation role to improve care management.
More than 50 percent of the children in Children’s Hospital – Greenville Hospital System service area enter school with an unidentified developmental or behavioral problem. Hospital staff created Pediatric Support Services to link families to existing community services as an answer to the current disjointed pediatric service coordination for children with special developmental, behavioral and psychosocial needs served by many health systems.
Nationwide Children's Hospital shares what makes them a leader in Quality 3.0, the next generation of quality in children's healthcare.
In February 2018, Yale New Haven Children’s Hospital moved into a new 68-bed, state-of-the-art single-room NICU and became the first U.S. academic medical center and children's hospital to implement postpartum/NICU mother-baby couplet care. The hospital designed special mother-baby rooms and created a new care model that spans two services.
Reporting patient safety events identifies and helps prevent harm, however, safety events remain underreported— particularly by physicians. Children’s Hospital of Richmond at VCU developed an innovative approach that successfully increased physician engagement in event reporting and ultimately enhanced the hospital’s culture of safety.
Seattle Children's explains the importance of a culture of standardization and describes the approach that has made them a leader in eliminating unnecessary variation.
Target-based care is a program leveraging personalized comparative effectiveness information derived from the electronic health record to provide transparent, real-time hospital goals for hospitalized patients. Lucile Packard Children's Hospital at Stanford provides follow-up data from experience with patients undergoing cardiac, orthopedic, and neurosurgical operations.
As hospitals continue to strive for zero harm, the growing need for robust data infrastructure continues. Rate-based measurements allow for comparison of performance over time but often only take into account events by individual metrics. Children’s Hospital Philadelphia created a “Harm Index” to display an aggregate rate to measure overall performance.
Putting Joy to Work
Seattle Children’s Hospital and Lucile Packard Children’s Hospital at Stanford showcase strategies for improving root cause analysis work through family involvement and process improvement.
Children’s Health Children’s Medical Center Dallas and Children’s Hospital & Medical Center use their experiences to deliver strategies for providing infection control to patients, families and staff.
Children's National Health System and Nationwide Children’s Hospital demonstrate how Appreciate Inquiry concepts and a quality improvement-driven morbidity and mortality conference can improve care.
Children's Hospital Colorado and UPMC Children’s Hospital of Pittsburgh showcase how partnerships among departments can produce better data and identify barriers to improve health outcomes.
Learn how children's hospitals are approaching the next generation of quality through integrated patient experience measurement models.
With individual department leadership and broad institutional culture of patient safety, pediatric behavioral health, otolaryngology, and orthopedics departments at Nationwide Children’s Hospital established robust quality improvement (QI) programs in clinically busy departments that reached combined annual outpatient visits over 278,000. Intradepartmental staff “buy-in”, culture change, and an effective infrastructure were integral to program success.
Staff at Penn State Children’s Hospital at the Milton S. Hershey Medical Center started a post acute care clinic using existing staff, space and no additional investment. Over three years, clinic volume has grown about 60 percent and patient satisfaction scores are in the 99th percentile.
Unfamiliar hospital environment causes stress for children with behavioral disorders like autism spectrum disorder. Perioperative health care teams are often poorly equipped to intervene when a child has severe distress and can cause disruption of care resulting in a longer length of stay. Children’s Healthcare of Atlanta developed an emergency medical record-based coping plan to provide tailored plans of care to limit stress.
Risks associated with sepsis and the rapidity at which it progresses cannot be overstated. Stony Brook Children’s Hospital developed an automated, real time electronic alert for patients who meet sepsis criteria. As a result, the hospital increased the number of sepsis patients identified and decreased overall sepsis mortality rates.
Cohen Children’s Medical Center sought to redefine care delivery for children with special needs. The BEE MINDFUL program uses an original Pediatric Neurobehavioral Assessment Tool and branded symbol to improve outcome measures. Implementation of this unique program created a shared mental model transforming care for this vulnerable pediatric population.
Children’s Hospital of Wisconsin built a medical neighborhood which integrates primary, specialty and urgent care. The goal was to decrease variation, improve quality, enhance family experience, and decrease the cost of care. The medical neighborhood advances the health care system’s strategic goals of population health, affordability, and convenience.
At its foundation, value-based care revolves around patients and requires pursuit of the Quadruple Aim: improved health, lower cost, improved experience of care for children and families, and provider joy. Learn how Boston Children’s Hospital’s care integration and measures deliver on the Quadruple Aim’s promise of high-value care.
The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative shares key drivers and results of efforts from their first two years.
Kentucky Children’s Hospital’s developmental and behavioral pediatric clinic, and graduate training program in applied behavior analysis coordinated care to address severe problem behavior. The partnership led to improved quality care for children with autism and other neurodevelopmental behavioral challenges while positively affecting families.
A national IV fluid shortage prompted staff at Children’s Hospital of Philadelphia to utilize formal improvement methodology as the backbone of an initiative to meet supply needs. The work of a multidisciplinary group resulted in sustained decrease in the hospital’s IV fluid use with no patient safety events.
A similar practice at separate hospitals caused serious safety events. Children’s Mercy Kansas City accelerated efforts to share serious harm concerns following the revelation. Attendees will hear from a family member whose story influenced industry change. Children’s Mercy Kansas City will describe how it is actively involved in sharing serious harm details in a protected learning organization so serious harm is not repeated elsewhere.
As pediatric hospital systems expand, it’s integral to maintain quality and safety standards across all locations. Boston Children’s Hospital developed a collaborative quality improvement learning community to promote engagement in initiatives across its expanding hospital system.
Using an integrated team process to examine inefficiencies, mobilize multi-disciplinary teams and pilot and sustain changes has resulted in our hospital successfully resolving complex system challenges using a standard approach. This approach has driven cost savings, improved clinical performance and has provided a roadmap for redesigning ineffective processes.
Nationwide Children’s Hospital aimed to reduce the wait times to new patients with behavioral health needs through a series of structured quality improvement efforts.
How one hospital made important clinical practice changes that produced measurable results within five months.
Learn how PEWS allow for real-time feedback and education of teams and individuals.
Dell Children's created a plan to integrate behavioral health into the children's hospital at the access point.
Program that individualizes care and promotes a safe place for healing and wellness.
Children's Health Network aims to improve how an organization of primary care facilities use an operational framework.
Electronic medical record (EMR) tools improve access to specialty care and reduce health care costs.
Sometimes the minute details in a children's hospital experience can greatly impact a patient's recovery, all by inspiring joy.
Children's Hospital Colorado outlines its approach to determining pediatric-specific recommendations for opioid prescribing.
Champions for Children's Health
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