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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

Meds to Beds: A Quality Improvement Approach to Optimizing the Discharge Medication Process for Pediatric Patients

Foster, Lauren; Choxi, Shivali; Rosenberg, Rebecca E; Tracy, Joanna; Toscano, Dante; Betancur Paez, Juan; Glick, Alexander F
BACKGROUND:Using an on-site pharmacy or medication to bedside (MTB) program allows patients to obtain prescriptions and education before discharge, potentially improving adherence and preventing harm. The aim of this project was to improve discharge processes for pediatric acute care patients by increasing the proportion of oral antibiotics (1) prescribed to the on-site pharmacy from 15% to 70% and (2) delivered to bedside from 0% to 50%. METHODS:The Model for Improvement was used to iteratively implement interventions: increased on-site pharmacy capabilities, MTB program creation and streamlined enrollment, and secure electronic health record (EHR) messaging between clinicians and pharmacy staff regarding prescriptions. Process measures were proportion of antibiotics prescribed to the on-site pharmacy and delivered to bedside. Outcomes included surveys of family satisfaction with discharge medication education and discharge medication-related safety reports. Discharge before noon (DBN) was the balancing measure. Aims were analyzed using statistical process control charts and chi-square tests. RESULTS:A total of 1,908 antibiotics were prescribed over 28-months. On-site pharmacy prescriptions increased from 15% to 46% after pharmacy capabilities increased, then to 86% after MTB program launch, optimized workflow, and initiation of EHR messaging. Bedside medication delivery increased from 0% to 58% with these interventions. Family satisfaction with discharge medication education and frequency of discharge medication-related safety reports was not significantly different pre- and postintervention. DBN varied throughout the study. CONCLUSION/CONCLUSIONS:Through clinician and pharmacy staff partnership, this initiative increased on-site pharmacy use and discharge antibiotics delivered to bedside. Key interventions included increased pharmacy capabilities, MTB program with streamlined workflow, and EHR-based communication.
PMID: 34740550
ISSN: 1938-131x
CID: 5184842

Implementation of Febrile Infant Management Guidelines Reduces Hospitalization

Foster, Lauren Z; Beiner, Joshua; Duh-Leong, Carol; Mascho, Kira; Giordani, Victoria; Rinke, Michael L; Trasande, Leonardo; Wiener, Ethan; Rosenberg, Rebecca E
The clinical management of well-appearing febrile infants 7-60 days of age remains variable due in part to multiple criteria differentiating the risk of a serious bacterial infection. The purpose of this quality improvement study was to standardize risk stratification in the emergency department and length of stay in the inpatient unit by implementing an evidence-based clinical practice guideline (CPG).
PMCID:7056289
PMID: 32190797
ISSN: 2472-0054
CID: 4352872