• Article
  • October 16, 2018

3 Clinical Care Improvement Projects

Clinical care improvement projects can change how a child receives care. Here's a look at the top Pediatric Quality Award entries from the clinical care category. 

The clinical care category of the Pediatric Quality Award takes a look at projects that aim to improve patient outcomes through the enhancement or redesign of clinical care systems. Learn more about three of the 2017 award's exceptional entries.

Reducing Emergency Department Visits in Children with Asthma 

When the team at Nationwide Children's Hospital in Columbus, Ohio, noticed emergency department (ED) visits for asthma within its primary care network (PCN) were high—there were more than 1,000 visits in 2010—the hospital sought to reduce asthma-related ED visits by 3 percent annually.

At the start of the project, there was no measurable standard of care for pediatric asthma cases within the PCN. Coupled with the PCN's patient demographics being mostly Medicaid-eligible, there was a high risk of asthma cases and morbidity. The team at Nationwide used several interventions to achieve its goal, including:

  • Adding alerts to the electronic medical record (EMR) system
  • Conducting asthma control tests during all visits
  • Adding two asthma health coaches to the team
  • Developing a metric to evaluate a patients' asthma control

"We prioritized this project due to the impact it could have on our large patient population," says Dane Snyder, M.D., clinical associate professor at Nationwide Children's. "Poor asthma control is associated with an increase in missed school days and impaired academic performance."

Compared to 2010, in 2016 the hospital saw a 24 percent reduction in ED visits for patients with asthma. This was a 4 percent annual decrease, which was 1 percent higher than the team's goal.

To learn more, register for Nationwide Children's live webcast on April 2, 2019.

Code Yellow

For pediatric oncology patients with severe neutropenia, their risk of an invasive bacterial infection is high. The Code Yellow project at Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, Tennessee, aimed to have a higher percentage of pediatric oncology patients with fever and neutropenia receive antibiotics in the ED within 60 minutes. The goal was 90 percent, a 60 percent increase from the start of the project.

To achieve this, the team implemented several interventions, including:

  • Stocking the right antibiotic in the electronic dispensing unit in the clinic
  • Incorporating a "fever" note onto the clinic whiteboard to identify patients in need of immediate triage
  • Using a clock to indicate when a "code yellow" patient is in the clinic, and how much time remains to get him or her a timely antibiotic 

"Standardization of care was the most important step in this process," says Caroline Epps, M.S.N., RN, quality and patient safety advisor, performance management and improvement at Monroe Carell.

The Code Yellow project started in May 2015, and by December, 89 percent of the targeted patient population had received antibiotics within 60 minutes.

To learn more, register for Monroe Carell's live webcast on Dec. 12.

Reducing Hospitalization with Nurse-driven Asthma Treatment

For children with acute asthma, early intervention in the ED with steroid and continuous versus intermittent beta agonists can prevent or reduce unnecessary hospitalization. In an attempt to standardize how these patients receive treatment for acute asthma in the ED, Primary Children's Hospital in Salt Lake City established a nurse-driven process that reduced the time it takes for a patient to receive appropriate treatment.

Using the Pediatric Health Information System (PHIS), Primary Children's knew its admission rates for this patient population was higher than their peer hospitals. Prior to the start of the project, 50.7 percent of acute asthma patients were admitted, with a project goal of 37.6 percent. The project team thought if it could provide 80 percent of acute asthma patients with steroids and albuterol within 60 minutes of being admitted to the ED to reduce hospital stays, the hospital would reach its goal.

The process change:

  • Allows nurses and respiratory therapists to practice at the top of their license, administering oral steroids and inhaler treatments using standardized assessments that are more accurate than relying on a physician's discretion
  • Frees physicians to focus on assessing patients post-treatment and determine an appropriate follow-up
  • Not only reduced hospital stays for lower-acuity asthmatics, but also helped hospitalized patients with asthma recover faster

In addition to reducing hospitalizations for 33 percent of patients—even more than the goal—Primary Children's decreased its average cost per-case from $2,820 to $2,131. Over a 12-month period, the hospital avoided $618,033 in costs.

Learn more by watching Primary Children's Hospital's recorded presentation:

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