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Using Quality Improvement Science to Promote Reliable Communication During Family-Centered Rounds
Glick, Alexander F; Foster, Lauren Z; Goonan, Michael; Hart, Louis H; Alam, Sadia; Rosenberg, Rebecca E
BACKGROUND AND OBJECTIVES/OBJECTIVE:Family-centered rounds (FCR) can lead to improved communication, satisfaction, and care delivery. However, FCR are variable in practice. Our primary goal was to implement and sustain consistent communication practices during FCR (a subset of all rounds in which parents were present) for patients on a pediatric hospital medicine service. We aimed to achieve 80% reliability for the following FCR practices: (1) discussion of risk factors and prevention strategies for hospital-acquired conditions (HACs), (2) discussion of discharge planning, and (3) asking families for questions. METHODS:Research assistants observed FCR on a pediatric acute care unit at an academic medical center and recorded if the rounding team discussed HAC risk factors, discussed discharge, or asked families for questions. Using the Model for Improvement, we performed multiple plan-do-study-act cycles to test and implement interventions, including (1) standardized note templates, (2) education via peer-led group discussions and team e-mails, and (3) routine provider feedback about performance. Data were analyzed by using statistical process control charts. RESULTS:From October 2017 to April 2019, reliability increased to >80% and sustained for (1) discussion of HAC risk factors (increased from 11% to 89%), (2) discussion of discharge planning (from 60% to 92%), and (3) asking families for questions (from 61% to 87%). Peer-led physician education, reminder e-mails, and physician engagement were the most impactful interventions corresponding to centerline shifts. CONCLUSIONS:Using multiple interventions, we achieved and sustained improvements in key communication-related elements of FCR. Future work will focus on determining if improved practices impact clinical outcomes.
PMID: 35362064
ISSN: 1098-4275
CID: 5201402
Racial and Ethnic Health Disparities Related to COVID-19
Lopez, Leo; Hart, Louis H; Katz, Mitchell H
PMID: 33480972
ISSN: 1538-3598
CID: 4781692
[S.l.] : Institute for Healthcare Improvement, 2020
Ingraining Equity into Quality and Safety: A System-Wide Strategy
IHI Multimedia Team; [Hart, Louis H; Wei, Eric K; Krouss, Mona; Segall, Jeremy; Roman, Matilde; Sheehy, Kwame; Bajaj, Komal]
(Website)CID: 4781712
Working Upstream in Advance Care Planning in Pandemic Palliative Care
Zaurova, Milana; Krouss, Mona; Israilov, Sigal; Hart, Louis; Jalon, Hillary; Conley, Georgia; Luong, Khoi; Wei, Eric K; Smeltz, Robert; Frankenthaler, Michael; Nichols, Jeffrey; Cohen, Susan; Suleman, Natasha; Ivanyuk, Marina; Shulman, Pavel; Tala, Osbely; Parker, Lauren; Castor, Tita; Pearlstein, Nicole; Kavanagh, Elizabeth; Cho, Hyung J
PMID: 32706629
ISSN: 2326-5108
CID: 4534282
Adolescent with Ehlers danlos syndrome and acute pulmonary hemorrhage [Meeting Abstract]
Salas, A; Patel, A; Hart, L; Wen, A
Aims & Objectives: Patients with Ehlers-Danlos syndrome (EDS) have abnormal collagen production or secretion leading to hyperextensibility of the skin, hypermobility of the joints, and increased tissue fragility. Although uncommon, respiratory manifestations of EDS have been described. The typical causes of death in patients with EDS are viscus rupture and arterial hemorrhage. Some deaths have been attributed to pulmonary hemorrhage. We report a case of acute pulmonary hemorrhage as the presenting finding of granulatomatosis with polyangiitis in a child with EDS. Methods Case Report Results A 14-year-old female with EDS presented with a 2-month history of fever, fatigue, unintentional weight loss, arthralgias, myalgias, and progressive dyspnea. Chest radiography revealed diffuse alveolar opacities and laboratory evaluation revealed anemia and thrombocytopenia. Chest computed tomography (CT) showed pulmonary hemorrhage. Anti-neutrophil cytoplasmic antibodies targeting proteinase 3 were positive for granulomatosis with polyangiitis. She was admitted on highflow nasal cannula oxygen therapy and given pulse-dose intravenous methylprednisolone. Subsequent improvement in respiratory status was observed; she was treated with rituximab and weaned off oxygen. Patient was discharged home in stable condition on hospital day #5 and remained on oral prednisone, with a 4-week course of rituximab, and was started oral azathioprine. (Figure prsented). Conclusions To our knowledge this is the first reported case of polyangiitis with granulomatosis presenting with pulmonary hemorrhage in a child with EDS. An increased index of suspicion may improve outcomes
EMBASE:623815443
ISSN: 1947-3893
CID: 3287362