Assess the Effects of Social Determinants on Serious Safety Events
Various social determinants such as race, gender, socioeconomic status can affect health outcomes, including readmission rates and mortality. Children’s Mercy Kansas City sought to understand the role social determinants may play in contributing to serious safety events and to then incorporate this knowledge into consideration for corrective action plan items. Each staff member interviewed after a potential serious safety event is asked a standardized question regarding the possible influence of any social determinants of health.
Build Improvement Capability Through Interdisciplinary Education at a Pediatric Hospital
Engaging healthcare workers in improvement initiatives is essential to achieving the Triple Aim and improving the domains of health care quality. To build improvement capacity and capability at Children’s Hospital of Philadelphia, the Improvement Education Program (IEP) was established in 2015 to provide a range of educational offerings for learners at multiple stages of experience. The IEP aims to provide staff with the ability to incorporate improvement into their strategic priorities and daily work.
Empower Frontline Staff Through Huddles and Idea Boards
A healthy work environment survey at Franciscan Children’s identified the opportunity to increase the involvement of frontline staff in decision making. At the time, a leader-led performance improvement structure contributed to minimal staff involvement, low retention, and poor communication. The implementation of daily huddles and idea boards provided a system to effectively communicate while promoting staff engagement and involvement in decision making to improve quality and safety. The work helped reduce RN turnover rates to below the national average.
Impact of Physician Alignment on Clinical Effectiveness
An initiative at Riley Hospital for Children at Indiana University Health demonstrated that embedding physicians in clinical effectiveness work will transform the culture of an organization toward a stronger value focus. The hospital s accomplished Increased physician alignment via a monthly meeting aiming to standardize the process improvement efforts. During the first 12 months, 75% of the organization’s medical directors identified a project and scheduled a time to present results.
Implementing Medication Safety Interventions Using a Multidisciplinary Team Approach
The quality group at James and Connie Maynard Children’s Hospital developed a multidisciplinary team to review medication safety events. Monthly review of reported medication-related safety events identified opportunities for process improvements and education across units and disciplines. The group recognized high-risk insulin events as a priority for initially focused interventions. Education of staff and ordering providers, pharmacy process mapping, administration practices, and technology influences were optimized through trended events.
Improving Efficiency and Caregiver Satisfaction in Patient-Provider EMR Messaging
Patients seek computerized access to health care information and professionals in many health care systems. Cleveland Clinic Children’s provides secure Emergency Medical Record (EMR) messaging, for patient communication between the patient and their care team. The project measured missed message rates, caregiver use of standardized documentation, level of comfort in replying to messages and burnout related to messages as reported by survey responses before and after the intervention.
Increase Access to Ambulatory Behavioral Health Care
The requests for behavioral health services at Children’s Hospital of Philadelphia exceeded what staff could support. To increase patient access, the outpatient division designed a new patient intake model known as the Assessment and Resource Center (ARC). Master’s level social workers partnered with licensed behavioral health providers to complete biopsychosocial assessments and recommendations for next steps. The pilot decreased time from initial call to appointment by 66%.
Initiative To Decrease Nosocomial C.difficile Infections
Presenter: Brianna Concannon, MHA, Performance Improvement Coordinator, Cohen Children's Medical Center
Nosocomial C. difficile infections (CDI) are associated with costs and morbidity. Cohen Children’s Medical Center aimed to decrease nosocomial CDI rates by 20% by January 2020. A multi-disciplinary team used a multi-modal approach focusing on lab stewardship, cleaning practices, reliable infection control practices, and antimicrobial stewardship using the model for improvement. The work successfully reduced oncology unit CDI rates, decreased testing in patients less than 2 years of age and lowered antibiotic use.
Maximize Comfort, Minimize Pain
A survey of bedside nurses at Dell Children’s Medical Center of Central Texas on the different comfort measures revealed a huge gap between nursing staff and parent perceptions regarding pain control for the patient. Since a hospital goal is to maximize comfort and minimize pain, staff worked to bridge the gap. Coaching, introducing tools for the bedside staff and education helped people understand the ‘why’ behind the initiative.
Path to Excellence in the NICU: Create Strategy and Structure
Presenter: Shelley Moore-White, MSM, BSN, RN, Nursing Director, Critical Care & Transport Services, East Tennessee Children's Hospital
A NICU leadership team at East Tennessee Children’s Hospital created a multi-faceted strategic plan to address improving clinical outcomes, staff engagement, and overall patient experience. The unit historically had staff involvement in unit councils and projects, however, participation was primarily from a few staff members. Using team structure, council structure, and a clinical path program resulted in vast improvements in neonatal clinical outcomes, patient experience, staff engagement and retention.
Rapid Response Bag Promotes Efficient Care in Pediatric Acute Units
Presenter: Jaime Lelle, RN, BSN, CPN, Nurse Educator, Stony Brook Children's Hospital
Bedside nursing staff at Stony Brook Long Island Children’s Hospital recognized that not all of the supplies needed for a Rapid Response Team (RRT) were easily accessible during an RRT call. The previous process to gather supplies wasted time, resources and supplies. Valuing bedside staff ideas lead to a change in practice and the creation of the RRT bag. The change acknowledged staff comfort level and created a process improvement where the bedside staff proactively addressed concerns.
STAR - A Comprehensive Approach to Disruptive Behavior
Staff at Levine Children’s Hospital noted a growing trend of pediatric patients expressing disruptive behavior; in response, the hospital created a Pediatric Disruptive Behavior Taskforce. They reviewed programs implemented in other children’s hospitals and selected components that would work in their environment. STAR (Safety Trained Action Response) includes an algorithm for identification and response to patients and families at risk for disruptive behavior. A STAR visual cue is used to make teammates aware of these patients.
Supporting YOU: More Than a Second Victim Program
While the term “second victim” has been well described, a largely unmet need for emotional support following adverse events remains. To meet the emotional needs of health care providers as well as dispel the stigma associated with mental health, West Virginia University Children’s Hospital created a 70-member, multi-disciplinary peer support team. The team consists of members from every licensed discipline within the hospital and is available to all staff 24/7.
The Right Approach Matters: Achieve Quality Outcomes and Improve Financial Performance
By combining tested methods with an intentional focus on the pediatric population, Mercy Kids has improved quality outcomes while simultaneously promoting financial performance. The system serves more than 300,000 kids across more than 40 hospitals and 175 clinics. Tactics for success include creating value-add for providers, toolkit templates for individualized implementation and an enterprise-wide approach to data analytics.
Therapeutic Listening for Postpartum Depression and Anxiety in the NICU
Postpartum depression and anxiety affect 1 in 7 mothers nationally, and mothers of critically ill newborns are at a higher risk of depression, anxiety, and post-traumatic stress related to traumatic birth experiences and infant condition The Therapeutic Listening Program at Advocate Children’s Hospital, provides early screening and support at the bedside which helps to keep mothers actively participating in their infant’s care and improves parent engagement. The program also reinforces the family-centered care approach.