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Pediatric ED Saves: Analyzing the ED Screen of Direct Admissions. 儿科急诊室救治:分析急诊室直接入院筛查。
IF 1.2 Q3 PEDIATRICS Pub Date : 2023-08-07 eCollection Date: 2023-07-01 DOI: 10.1097/pq9.0000000000000678
Fatima Ramirez-Cueva, Gary Prusky Grinberg, Ann Marie Kuchinski, Robert Gibson, Hongyan Xu, Li Fang Zhang, Desiree Seeyave

Direct admissions (DAs) are a routine hospital entry portal with few guidelines to assess patient safety during this process. This study assessed the effectiveness of an institutional screen for patients presenting as DA. It investigated patient variables that may predict appropriateness for DA and those at high risk for deterioration.

Methods: The study includes patients who received the institutional screen between June 1, 2019, and May 31, 2020. We placed charts into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to pediatric intensive care unit within 6 hours). We assessed effectiveness by calculating sensitivity, specificity, and predictive values. We used comparative analysis between groups to identify patients safe for DA and those at high risk for deterioration.

Results: The screen was 80% sensitive and 100% specific, predicting 97.7% of stable patients. Of the 652 charts reviewed, 384 met the inclusion criteria. Group 1 (31.60, 26.45%, 5.23%) had lower respiratory rate, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO2, group 1 (98.70) was higher than group 2 (96.03). For the Pediatric Early Warning Score, group 2 (1.72) was higher than group 1 (0.31) and group 3 (0.63).

Conclusions: The institutional screen is an effective tool to identify patients presenting as DA needing immediate emergency department intervention and/or pediatric intensive care unit care. The screen benefits patients with a respiratory diagnosis, oxygen requirement, high respiratory rate or low SpO2.

直接入院(DA)是医院的一个常规入院途径,但在此过程中几乎没有评估患者安全的指南。本研究评估了对直接入院患者进行机构筛查的有效性。研究还调查了可预测是否适合直接入院以及病情恶化高风险患者的患者变量:研究对象包括在 2019 年 6 月 1 日至 2020 年 5 月 31 日期间接受机构筛查的患者。我们将病历分为三组:第 1 组(病情稳定)、第 2 组(病情不稳定)和第 3 组(病情稳定后在 6 小时内转入儿科重症监护室)。我们通过计算灵敏度、特异性和预测值来评估有效性。我们通过组间比较分析来确定哪些患者可以接受DA治疗,哪些患者病情恶化的风险较高:筛查的敏感性为 80%,特异性为 100%,可预测 97.7% 的病情稳定患者。在审查的 652 份病历中,有 384 份符合纳入标准。与第 2 组(45.00, 78.13%, 15.63%)和第 3 组(44.50, 75.00%, 50.00%)相比,第 1 组(31.60, 26.45%, 5.23%)的呼吸频率、呼吸诊断和氧气需求较低。在 SpO2 方面,第 1 组(98.70)高于第 2 组(96.03)。在儿科预警评分方面,第 2 组(1.72)高于第 1 组(0.31)和第 3 组(0.63):机构筛查是一种有效的工具,可以识别出需要急诊科立即干预和/或儿科重症监护室护理的 DA 患者。该筛查对有呼吸系统诊断、需氧、高呼吸频率或低 SpO2 的患者有益。
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引用次数: 0
Reducing Postoperative Length of Stay for Idiopathic Scoliosis Patients using Quality Improvement Methodology. 使用质量改进方法减少特发性脊柱侧凸患者术后住院时间。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000672
Crystal Seilhamer, Kelly Miller, Jessica Holstine

Approximately 1%-3% of the US population is diagnosed with scoliosis. In addition, 80% of those diagnosed have idiopathic scoliosis, with about 10% requiring surgical intervention. This Quality Improvement initiative aimed to reduce the length of stay (LOS) after posterior spinal fusion for these patients. According to the Pediatric Health Information System, our institution had a poorer performance, with an actual LOS greater than or equal to the expected LOS compared with peer institutions.

Methods: The aim was to increase the percentage of idiopathic scoliosis patients with a procedure to discharge LOS of less than or equal to 4 days after posterior spinal fusion from 39.13% to 90%. Interventions included implementing a new pain management protocol, a daily checklist, education on expectations of postoperative pain, and updated order sets.

Results: Interventions improved patients discharged in less than 4 days from 39.13% to 93.48% (P ≤ 0.001), reducing the average postprocedure LOS from 4.93 to 2.59 (P ≤ 0.001) days. A key process measure tracked was the percentage of patients off the patient-control analgesia pump by postoperative day 2, which increased from 13% to 97.75% (P ≤ 0.001). These improvements did not affect the balancing measure of readmissions or Emergency Department visits for pain.

Conclusions: By implementing a more standardized pathway, including a patient-focused daily checklist for providers and families, we established expectations for LOS and pain. This checklist and updates to the pain management protocol successfully reduced the length of stay in idiopathic scoliosis patients after posterior spinal fusion.

大约1%-3%的美国人被诊断患有脊柱侧凸。此外,80%被诊断为特发性脊柱侧凸,约10%需要手术干预。这项质量改进计划旨在减少这些患者后路脊柱融合后的住院时间(LOS)。根据儿科健康信息系统,我们的机构表现较差,与同行机构相比,实际LOS大于或等于预期LOS。方法:目的是增加特发性脊柱侧凸患者在后路脊柱融合术后少于或等于4天解除LOS的比例,从39.13%增加到90%。干预措施包括实施新的疼痛管理方案、每日检查表、关于术后疼痛预期的教育和更新的医嘱集。结果:干预措施使4天内出院的患者从39.13%减少到93.48% (P≤0.001),使平均术后LOS从4.93天减少到2.59天(P≤0.001)。跟踪的一个关键过程测量是术后第2天停用患者自控镇痛泵的患者百分比,从13%增加到97.75% (P≤0.001)。这些改善不影响再入院或因疼痛就诊的平衡措施。结论:通过实施更标准化的途径,包括为提供者和家庭提供以患者为中心的每日检查表,我们建立了对LOS和疼痛的期望。这份检查表和疼痛管理方案的更新成功地减少了特发性脊柱侧凸患者后路脊柱融合术后的住院时间。
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引用次数: 0
Quality Improvement to Eliminate Disparities in Developmental Screening for Patients Needing Interpreters. 质量改进以消除需要口译员的患者发育筛查的差异。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000679
Courtney M Brown, Beth Dillon, Christina Toth, Emily Decker, Robin N Alexander, Aarti R Chandawarkar, Stefanie Bester, Elizabeth Ricket, Dane A Snyder

Children from households with a preferred language other than English are less likely to receive timely identification and treatment for developmental delay than children of native English speakers. In dismantling this inequity, the role of primary care pediatrics is to establish equitable systems for screening and referral. This project, conducted in a network of twelve pediatric primary care centers, focused on eliminating a small but systematic disparity in developmental screening rates between families who did and did not require interpreters (86% versus 92%). The specific aim was to increase developmental screen completion among patients needing interpreters from 86% to 92% of age-appropriate well-child visits.

Methods: Data were extracted from the electronic health record (EHR) to measure the proportion of 9-, 18-, 24-, and 30-month well-child visits at which developmental screens were completed, stratified by interpreter need (n = 31,461 visits; 7500 needing interpreters). One primary care center tested small changes to standardize processes, eliminate workarounds, and leverage EHR features using the Institute for Healthcare Improvement's Model for Improvement. The QI team plotted screen completion on control charts and spread successful changes to all 12 clinics. Statistical process control evaluated the significance of changes in screening rates.

Results: For patients needing interpreters, screen completion rose across all clinics from 86% to 93% when the clinics implemented the new process. Screen completion for patients not needing interpreters remained at 92%.

Conclusion: A standardized process supported by the EHR improved developmental screening among patients needing interpreters, eliminating disparities.

与母语为英语的孩子相比,来自母语非英语家庭的孩子更不可能及时得到发育迟缓的识别和治疗。在消除这种不平等的过程中,初级保健儿科的作用是建立公平的筛查和转诊制度。该项目在一个由12个儿科初级保健中心组成的网络中进行,重点是消除需要口译员和不需要口译员的家庭之间在发育筛查率方面存在的微小但系统的差异(86%对92%)。具体目标是将需要口译员的患者的发育筛查完成率从86%提高到92%。方法:从电子健康记录(EHR)中提取数据,测量9个月、18个月、24个月和30个月的健康儿童就诊中完成发育筛查的比例,按译员需求分层(n = 31,461次;7500需要口译员)。一家初级保健中心测试了一些小的变化,以标准化流程、消除变通方法,并使用医疗保健改进研究所的改进模型来利用EHR功能。QI团队在控制图上绘制了屏幕完成情况,并将成功的更改传播给所有12家诊所。统计过程控制评估筛查率变化的意义。结果:对于需要口译员的患者,当诊所实施新流程时,所有诊所的筛查完成率从86%上升到93%。不需要口译员的患者的筛查完成率保持在92%。结论:EHR支持的标准化流程改善了需要口译员的患者的发育筛查,消除了差异。
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引用次数: 0
Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project. 新生儿重症监护病房到出院家庭的沟通:一个质量改进项目。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000669
Priyam Pattnaik, Suhas Nafday, Robert Angert

Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children's Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans.

Methods: We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change.

Results: Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients.

Conclusion: A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.

新生儿重症监护病房(NICU)毕业生在出院后需要复杂的服务。纽约州布朗克斯Montefiore-Weiler儿童医院的新生儿重症监护病房(NICU)出院流程缺乏常规初级保健提供者(PCP)通知系统。在这里,我们描述了一个质量改进项目,以改善与pcp的沟通,以确保关键信息和计划的沟通。方法:我们组建了一个多学科团队,收集出院沟通频率和质量的基线数据。我们使用质量改进工具来实现更高质量的系统。结果测量是向PCP成功交付标准化通知和出院摘要。我们通过多学科会议和直接反馈收集了定性数据。平衡措施包括在放电过程中花费的额外时间和传递错误信息。我们使用运行图来跟踪进度并推动变更。结果:基线数据显示,67%的pcp在出院前未收到通知,即使pcp收到通知,出院计划也不明确。PCP反馈导致了主动的电子通信和标准化通知。关键驱动图允许团队设计导致可持续变化的干预措施。经过多个计划-执行-研究-行动周期后,电子PCP通知的发送率超过90%。对收到通知的儿科医生的调查表明,这些通知非常有价值,并有助于这些高危患者的护理过渡。结论:包括社区儿科医生在内的多学科团队是将新生儿重症监护病房出院PCP通报率提高到90%以上,传递更高质量信息的关键。
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引用次数: 0
Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits. 改善儿童门诊就诊儿科高血压指南的依从性。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000670
Ei Ei Khin, Maria Theresa Villanos, Juliana Garcia Alvarado, David Rodriguez, Bisma Arbab, Kris Nicole De Guzman

Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.

Methods: The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.

Results: Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%-100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.

Conclusion: Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.

儿童期高血压可导致青年期心血管疾病的发病率和死亡率。我们的目标是提高美国儿科学会推荐的血压(BP)指南步骤的依从性,9至18岁的儿童在12个月内就诊时血压达到75%。方法:对医护人员进行美国儿科学会高血压临床实践指南的教育。我们将指南步骤整合到电子病历(EMR)中,并分析了结果测量。结果测量为:(1)表中记录的血压,(2)门诊人员简化的血压表筛查,(3)提供者重复手动血压,(4)血压分类,(5)记录血压分类,(6)管理计划,(7)随访计划。根据每个计划-执行-研究-行动(PDSA)周期制定具体的干预措施,包括重新教育指导方针,重新强调遵循电子病历步骤,并向提供者提供个性化的反馈和警报。结果:在第二次PDSA循环后,7项结果测量中有6项(除提供者重复手动BP外)达到86%-100%的范围。注释运行图显示,在第四个PDSA循环中,供应商的重复手动BP从38%提高到89%。结论:经营健康儿童诊所的儿科住院医师通过提供教育并将提示和信息整合到EMR中,提高了对儿科高血压指南的依从性。
{"title":"Improved Compliance of Pediatrics High Blood Pressure Guidelines in Well-Child Clinic Visits.","authors":"Ei Ei Khin,&nbsp;Maria Theresa Villanos,&nbsp;Juliana Garcia Alvarado,&nbsp;David Rodriguez,&nbsp;Bisma Arbab,&nbsp;Kris Nicole De Guzman","doi":"10.1097/pq9.0000000000000670","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000670","url":null,"abstract":"<p><p>Childhood hypertension can lead to cardiovascular morbidity and mortality in young adult life. We aim to improve compliance with the American Academy of Pediatrics recommended blood pressure (BP) guideline steps to 75% over 12 months in children 9 to 18 years old during well-child visits.</p><p><strong>Methods: </strong>The providers were educated on American Academy of Pediatrics high BP clinical practice guidelines. We integrated the guideline steps into the electronic medical record (EMR) and analyzed outcome measures. The outcome measures were: (1) BP recorded in the chart, (2) screening done by simplified BP table by clinic staff, (3) repeat manual BP by the provider, (4) BP classification, (5) documentation of BP classification, (6) management plan, and (7) follow-up schedule. Specific interventions were made based on each plan-do-study-act (PDSA) cycle, including reeducating the guidelines, reemphasizing following the EMR steps, and providing providers with individualized feedback and alerts.</p><p><strong>Results: </strong>Six of 7 outcome measures (except repeat manual BP by provider) achieved 86%-100% range after the second PDSA cycle. The annotated run chart demonstrates that repeat manual BP by provider improved from 38% to 89% in the fourth PDSA cycle.</p><p><strong>Conclusion: </strong>Pediatric residents who run well-child clinics improved adherence to pediatric high BP guidelines by providing education and integrating prompts and information into the EMR.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e5/00/pqs-8-e670.PMC10403019.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9960143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reducing Human Album Solution Use in the Pediatric Intensive Care Unit. 减少小儿重症监护病房中人体相册溶液的使用。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000667
Yu Inata, Etsuko Nakagami-Yamaguchi, Takeshi Hatachi, Yukie Ito, Takaaki Akamatsu, Muneyuki Takeuchi

Evidence for outcome improvement is limited for using 5% human albumin solution (5% albumin) in pediatric intensive care units (PICUs). However, 5% albumin was injudiciously used in our PICU. Therefore, we aimed to decrease 5% albumin use in pediatric patients (17 years old or younger) in the PICU by 50% in 12 months to improve health care efficiency.

Methods: We plotted the mean 5% albumin volume used per PICU admission monthly on statistical process control charts through 3 study periods: baseline period before intervention (July 2019-June 2020), phase 1 (August 2020-April 2021), and phase 2 (May 2021-April 2022). With intervention 1, education, feedback, and an alert sign on 5% albumin stocks began in July 2020. This intervention continued until May 2021, when we executed intervention 2, removing 5% albumin from the PICU inventory. We also examined the lengths of invasive mechanical ventilation and PICU stay as balancing measures across the 3 periods.

Results: Mean 5% albumin consumption per PICU admission decreased significantly from 48.1 to 22.4 mL after intervention 1 and 8.3 mL after intervention 2, with the intervention effects persisting for 12 months. Costs associated with 5% albumin per PICU admission significantly decreased by 82%. In terms of patient characteristics and balancing measures, the 3 periods were not different.

Conclusions: Stepwise quality improvement interventions, including the system change with the elimination of the 5% albumin inventory from the PICU, were effective in reducing 5% albumin use in the PICU with sustained reduction.

在儿科重症监护病房(picu)使用5%人白蛋白溶液(5%白蛋白)改善结果的证据有限。然而,在我们的PICU中使用5%白蛋白是不明智的。因此,我们的目标是在12个月内将PICU儿科患者(17岁或以下)白蛋白的使用减少50%,以提高医疗效率。方法:我们在统计过程控制图上绘制了3个研究阶段:干预前基线期(2019年7月- 2020年6月)、第一阶段(2020年8月- 2021年4月)和第二阶段(2021年5月- 2022年4月),每个PICU入院每月平均使用5%白蛋白体积。通过干预、教育、反馈,并于2020年7月开始对5%的白蛋白库存发出警报。该干预一直持续到2021年5月,当时我们执行了干预2,从PICU库存中去除5%的白蛋白。我们还检查了有创机械通气和PICU停留时间作为3个时期的平衡措施。结果:每次PICU入院5%白蛋白平均消耗量从干预1后的48.1 mL下降到22.4 mL,干预2后的8.3 mL,干预效果持续12个月。每次PICU入院5%白蛋白的相关费用显著下降82%。在患者特征和平衡措施方面,3个时期无明显差异。结论:逐步质量改进干预措施,包括从PICU中取消5%白蛋白库存的系统改变,可以有效地减少PICU中5%白蛋白的使用,并持续减少。
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引用次数: 0
Improving Postpartum Depression Screening in the NICU: Partnering with Students to Improve Outreach. 改善产后抑郁症筛查在新生儿重症监护室:与学生合作,以提高推广。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000674
Sinead Brady, Rochelle Steinwurtzel, Rachel Kim, Elena Abascal, Mariellen Lane, Sandhya Brachio

Infants born to mothers with postpartum depression (PPD) are at risk for adverse developmental outcomes. Mothers of premature infants are 40% more likely to develop PPD when compared with the general population. Current published studies on implementing PPD screening in the Neonatal Intensive Care Unit (NICU) do not comply with the American Academy of Pediatrics (AAP) guideline, which recommends multiple screening points in the first year postpartum and includes partner screening. Our team implemented PPD screening that follows the AAP guideline and includes partner screening for all parents of infants admitted to our NICU beyond 2 weeks of age.

Methods: The Institute For Healthcare Improvement Model for Improvement was the framework for this project. Our initial intervention bundle included provider education, standardized identification of parents to be screened, and bedside screening performed by the nurse with social work follow-up. This intervention transitioned to weekly screening by phone by health professional students and the use of the electronic medical record for notification of team members of screening results.

Results: Under the current process, 53% of qualifying parents are screened appropriately. Of the parents screened, 23% had a positive Patient Health Questionnaire-9 requiring referral for mental health services.

Conclusions: Implementing a PPD screening program that complies with the AAP standard is feasible within a Level 4 NICU. Partnering with health professional students greatly improved our ability to screen parents consistently. Given the high percentage of parents with PPD uncovered with appropriate screening, this type of program has a clear need within the NICU.

产后抑郁症(PPD)母亲所生的婴儿有不良发育结果的风险。与一般人群相比,早产婴儿的母亲患产后抑郁症的可能性要高出40%。目前发表的关于在新生儿重症监护病房(NICU)实施PPD筛查的研究不符合美国儿科学会(AAP)指南,该指南建议在产后第一年进行多个筛查点,包括伴侣筛查。我们的团队按照AAP指南实施PPD筛查,包括对所有入住NICU的2周以上婴儿的父母进行伴侣筛查。方法:以美国卫生保健改进研究所改进模型为研究框架。我们最初的干预措施包括提供者教育、对需要筛查的家长进行标准化识别、由护士进行床边筛查并进行社会工作随访。这一干预措施转变为每周由卫生专业学生通过电话进行筛查,并使用电子病历通知团队成员筛查结果。结果:在现行程序下,53%符合条件的家长得到了适当的筛选。在接受筛查的父母中,23%的人有阳性的患者健康问卷-9,需要转介心理健康服务。结论:在4级新生儿重症监护室实施符合AAP标准的PPD筛查方案是可行的。与健康专业学生合作,大大提高了我们对家长进行持续筛查的能力。考虑到经过适当筛查的PPD家长比例很高,这种类型的项目在新生儿重症监护室有明显的需求。
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引用次数: 1
Let us to the TWISST; Plan, Simulate, Study and Act. 让我们去扭扭;计划,模拟,学习和行动。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000664
Nora Colman, Kiran B Hebbar

Translational Work Integrating Simulation and Systems Testing (TWISST) is a novel application of simulation that augments how we discover, understand, and mitigate errors in our system. TWISST is a diagnostic and interventional tool that couples Simulation-based Clinical Systems Testing with simulation-based training (SbT). TWISST tests environments and work systems to identify latent safety threats (LSTs) and process inefficiencies. In SbT, improvements made to the work system are embedded in hard wire system improvements, ensuring optimal integration into clinical workflow.

Methods: Simulation-based Clinical Systems Testing approach includes simulated scenarios, Summarize, Anchor, Facilitate, Explore, Elicit debriefing, and Failure Mode and Effect Analysis. In iterative Plan-Simulate-Study-Act cycles, frontline teams explored work system inefficiencies, identified LSTs, and tested potential solutions. As a result, system improvements were hardwired through SbT. Finally, we present a case study example of the TWISST application in the Pediatric Emergency Department.

Results: TWISST identified 41 latent conditions. LSTs were related to resource/equipment/supplies (n = 18, 44%), patient safety (n = 14, 34%), and policies/procedures (n = 9, 22%). Work system improvements addressed 27 latent conditions. System changes that eliminated waste or modified the environment to support best practices mitigated 16 latent conditions. System improvements that addressed 44% of LSTs cost the department $11,000 per trauma bay.

Conclusions: TWISST is an innovative and novel strategy that effectively diagnoses and remediates LSTs in a working system. This approach couples highly reliable work system improvements and training into 1 framework.

翻译工作集成仿真和系统测试(TWISST)是一种新颖的仿真应用,它增强了我们如何发现、理解和减轻系统中的错误。TWISST是一种诊断和介入工具,结合了基于模拟的临床系统测试和基于模拟的培训(SbT)。TWISST测试环境和工作系统,以识别潜在的安全威胁(lst)和流程效率低下。在SbT中,对工作系统的改进嵌入在硬线系统改进中,确保最佳地集成到临床工作流程中。方法:基于模拟的临床系统测试方法包括模拟场景、总结、锚定、促进、探索、引出汇报、失败模式和效果分析。在迭代的计划-模拟-研究-行动周期中,一线团队探索工作系统的低效率,确定lst,并测试潜在的解决方案。因此,系统改进是通过SbT进行的。最后,我们提出了TWISST在儿科急诊科应用的案例研究示例。结果:TWISST鉴别出41种潜在条件。lst与资源/设备/用品(n = 18, 44%)、患者安全(n = 14, 34%)和政策/程序(n = 9, 22%)有关。工作制度改善,解决隐患27个。消除浪费或修改环境以支持最佳实践的系统变更减轻了潜在条件。系统改进解决了44%的lst,每个创伤室花费了该部门11,000美元。结论:TWISST是一种创新和新颖的策略,可以有效地诊断和修复工作系统中的lst。这种方法将高度可靠的工作系统改进和培训结合到一个框架中。
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引用次数: 0
Increasing Engagement of Imaging Professionals in Quality Improvement Using an Encounter-specific Quality-reporting Tool. 使用特定的质量报告工具提高成像专业人员在质量改进中的参与度。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000673
Lynne Ruess, Benjamin P Thompson, Erin L Mesi, Margarita Chmil, Nicholas A Zumberge, Kari Jorgenson, Rajesh Krishnamurthy

The involvement of pediatric imaging professionals in quality improvement (QI) in our department was low, with few available informatics tools to report issues or suggest improvement opportunities in a timely and efficient manner. We aimed to increase QI engagement in radiology by creating a real-time, encounter-specific reporting tool embedded into the clinical imaging workflow.

Methods: A multidisciplinary team outlined requirements for a new electronic quality-reporting tool, including point-of-care access during imaging workflow and simultaneous automatic capture of encounter-specific clinical information from the hospital information system. Information system experts created a user-friendly interface for categories based on stages of imaging workflow (Planning, Acquisition, Processing, Interpretation, Communication, and Data Collection). Team members trained all department staff. Quality coordinators sorted entries and monitored personnel engagement for two 36-week periods: immediately after launch and 3 years later. Descriptive statistics were used to analyze proposed and completed QI projects during these periods.

Results: There were 1,498 entries during the first 36 weeks. Ninety-three percent of radiologists and 56% of technologists participated. Three years later, there were 1,251 entries in 36 weeks. Data collection entries for established QI projects increased from 380 (25%) to 487(39%). The engagement continued among radiologists but decreased among technologists over time. Submissions for QI projects increased from baseline. The project completion rate increased.

Conclusion: We created a QI reporting tool embedded into the clinical imaging workflow, which improved the participation of our imaging professionals and increased the number of completed QI projects.

在我科,儿科影像专业人员对质量改进(QI)的参与度较低,缺乏可用的信息工具来及时有效地报告问题或提出改进机会。我们的目标是通过创建一个嵌入到临床成像工作流程中的实时、遭遇特定的报告工具来提高放射学中QI的参与度。方法:一个多学科团队概述了一种新的电子质量报告工具的需求,包括成像工作流程中的护理点访问和同时从医院信息系统自动捕获遇到的特定临床信息。信息系统专家根据成像工作流程的各个阶段(规划、获取、处理、解释、通信和数据收集)创建了一个用户友好的界面。团队成员培训所有部门员工。质量协调员对条目进行分类,并在两个36周的周期内监测人员敬业度:发布后立即和3年后。描述性统计用于分析这些时期提出的和完成的QI项目。结果:前36周共入组1498例。93%的放射科医生和56%的技术专家参与了调查。三年后,36周内有1251个参赛作品。已建立的QI项目的数据收集条目从380(25%)增加到487(39%)。随着时间的推移,放射科医生的参与度继续保持,但技术专家的参与度有所下降。QI项目的提交量从基线开始增加。项目完成率提高。结论:我们创建了一个嵌入到临床成像工作流程中的QI报告工具,提高了我们的成像专业人员的参与度,并增加了完成QI项目的数量。
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引用次数: 1
"It's a Different Conversation": Qualitative Analysis of Pediatric Home-based Hospice/Palliative Care Visits' Perceived Value. “这是一个不同的对话”:儿科居家安宁疗护/缓和疗护访视感知价值的定性分析。
Q3 Medicine Pub Date : 2023-07-01 DOI: 10.1097/pq9.0000000000000663
Daniel H Grossoehme, Jaime Sellers, Samuel Accordino, Steven M Smith, Rachel Jenkins, Gwendolyn Richner, Yolanda Moore-Forbes, Sarah Friebert

Home-based hospice and/or palliative care (HBHPC) is an important and increasingly utilized aspect of care for children with serious conditions-those with high mortality risk, which either impacts their quality of life or carries a significant caregiver burden. Provider home visits are a core feature; however, the travel time and human resource allocation are significant challenges. Balancing the appropriateness of this allocation requires further characterization of the value of home visits to families and identification of the value domains of HBHPC for caregivers. For study purposes, we defined a "home visit" as an in-person visit by a physician or advanced practice provider to a child's residence.

Methods: The methods include a qualitative study using semistructured interviews and a grounded theory analytic framework enrolled caregivers of children aged 1 month to 26 years receiving HBHPC from either of 2 U.S. pediatric quaternary institutions between 2016 and 2021.

Results: Twenty-two participants were interviewed; the mean (SD) interview duration was 52.9 (22.6) minutes. The final conceptual model has 6 major themes: communicating effectively, fostering emotional and physical safety, building and maintaining relationships, empowering the family, seeing the bigger picture, and sharing burdens.

Conclusions: Caregiver-identified themes demonstrated improved communication, empowerment, and support from receiving HBHPC, which can facilitate enhanced family-centered, goal-concordant care.

以家庭为基础的安宁疗护和/或缓和疗护(HBHPC)是照顾严重疾病儿童的一个重要且越来越多的方面,这些严重疾病是指那些有高死亡率风险的儿童,这些儿童要么影响他们的生活质量,要么带来重大的照护负担。提供者家访是一个核心功能;然而,旅行时间和人力资源分配是重大挑战。平衡这种分配的适当性需要进一步表征家庭家访的价值,并确定照顾者的HBHPC的价值域。出于研究目的,我们将“家访”定义为医生或高级实践提供者对儿童住所的亲自访问。方法:采用半结构化访谈和基于理论的分析框架进行定性研究,招募了2016年至2021年间在美国两家儿科第四医院接受hbpc治疗的1个月至26岁儿童的护理人员。结果:共访谈22名参与者;平均(SD)访谈时间为52.9(22.6)分钟。最后的概念模型有6个主要主题:有效沟通,培养情感和身体安全,建立和维持关系,赋予家庭权力,看到更大的前景,分担负担。结论:护理人员确定的主题表明,通过接受hbpc,可以改善沟通、授权和支持,这可以促进以家庭为中心、目标和谐的护理。
{"title":"\"It's a Different Conversation\": Qualitative Analysis of Pediatric Home-based Hospice/Palliative Care Visits' Perceived Value.","authors":"Daniel H Grossoehme,&nbsp;Jaime Sellers,&nbsp;Samuel Accordino,&nbsp;Steven M Smith,&nbsp;Rachel Jenkins,&nbsp;Gwendolyn Richner,&nbsp;Yolanda Moore-Forbes,&nbsp;Sarah Friebert","doi":"10.1097/pq9.0000000000000663","DOIUrl":"https://doi.org/10.1097/pq9.0000000000000663","url":null,"abstract":"<p><p>Home-based hospice and/or palliative care (HBHPC) is an important and increasingly utilized aspect of care for children with serious conditions-those with high mortality risk, which either impacts their quality of life or carries a significant caregiver burden. Provider home visits are a core feature; however, the travel time and human resource allocation are significant challenges. Balancing the appropriateness of this allocation requires further characterization of the value of home visits to families and identification of the value domains of HBHPC for caregivers. For study purposes, we defined a \"home visit\" as an in-person visit by a physician or advanced practice provider to a child's residence.</p><p><strong>Methods: </strong>The methods include a qualitative study using semistructured interviews and a grounded theory analytic framework enrolled caregivers of children aged 1 month to 26 years receiving HBHPC from either of 2 U.S. pediatric quaternary institutions between 2016 and 2021.</p><p><strong>Results: </strong>Twenty-two participants were interviewed; the mean (SD) interview duration was 52.9 (22.6) minutes. The final conceptual model has 6 major themes: communicating effectively, fostering emotional and physical safety, building and maintaining relationships, empowering the family, seeing the bigger picture, and sharing burdens.</p><p><strong>Conclusions: </strong>Caregiver-identified themes demonstrated improved communication, empowerment, and support from receiving HBHPC, which can facilitate enhanced family-centered, goal-concordant care.</p>","PeriodicalId":74412,"journal":{"name":"Pediatric quality & safety","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/21/pqs-8-e663.PMC10332824.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10190730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Pediatric quality & safety
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