ResearchPad - multi-institutional-collaborative-and-qi-network-research https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Pediatric Clinician Comfort Discussing Diagnostic Errors for Improving Patient Safety: A Survey]]> https://www.researchpad.co/article/elastic_article_7757 Meaningful conversations about diagnostic errors require safety cultures where clinicians are comfortable discussing errors openly. However, clinician comfort discussing diagnostic errors publicly and barriers to these discussions remain unexplored. We compared clinicians’ comfort discussing diagnostic errors to other medical errors and identified barriers to open discussion.Methods:Pediatric clinicians at 4 hospitals were surveyed between May and June 2018. The survey assessed respondents’ comfort discussing medical errors (with varying degrees of system versus individual clinician responsibility) during morbidity and mortality conferences and privately with peers. Respondents reported the most significant barriers to discussing diagnostic errors publicly. Poststratification weighting accounted for nonresponse bias; the Benjamini–Hochberg adjustment was applied to control for false discovery (significance set at P < 0.018).Results:Clinicians (n = 838; response rate 22.6%) were significantly less comfortable discussing all error types during morbidity and mortality conferences than privately (P < 0.004) and significantly less comfortable discussing diagnostic errors compared with other medical errors (P < 0.018). Comfort did not differ by clinician type or years in practice; clinicians at one institution were significantly less comfortable discussing diagnostic errors compared with peers at other institutions. The most frequently cited barriers to discussing diagnostic errors publicly included feeling like a bad clinician, loss of reputation, and peer judgment of knowledge base and decision-making.Conclusions:Clinicians are more uncomfortable discussing diagnostic errors than other types of medical errors. The most frequent barriers involve the public perception of clinical performance. Addressing this aspect of safety culture may improve clinician participation in efforts to reduce harm from diagnostic errors. ]]> <![CDATA[Handoff Communication between Remote Healthcare Facilities]]> https://www.researchpad.co/article/elastic_article_7751 Handoffs and transitions of care are common weak points in healthcare provider communication as patients move between sites. With no consistent pattern of communication between St. Jude Children’s Research Hospital (St. Jude) and its affiliated clinics, the Affiliate Program Office at St. Jude developed and implemented a standardized communication tool to facilitate patient transitions between different healthcare sites.Methods:Each team of providers created flow diagrams to define the current state of communication when patients were transitioning between remote sites. Fishbone diagrams identified the common barriers to effective communication as a lack of consistent communication and ownership. We developed a communication tool to address these barriers, which was disseminated by secure email. We measured the percent usage of the completed hand-off tool before a patient transitioned, staff experience, and the number of errors.Results:The time to send or receive the communication bundle was <10 minutes. Within 3 months of implementing the SMART bundle at 3 pilot sites, the bundle was used completely in 6 of 8 patient transitions and was associated with somewhat improved staff satisfaction. We identified no adverse events related to the communication bundle.Conclusions:In this small pilot study, we accomplished closed-loop communication between geographically remote healthcare sites by using an electronically transmitted standardized communication bundle. ]]> <![CDATA[Preschool Vision Screening Collaborative: Successful Uptake of Guidelines in Primary Care]]> https://www.researchpad.co/article/N65241eda-4bc6-4269-9883-d5a3b589ddab

Introduction:

Preschool vision screening rates in primary care are suboptimal and poorly standardized. The purpose of this project was to evaluate pediatric primary care adherence to and improvement in preschool vision screening guidelines through a learning collaborative environment.

Methods:

Thirty-nine Ohio primary care providers interested in preschool vision screening self-selected to participate in an Institute for Healthcare Improvement Breakthrough Series learning collaborative that spanned 18 months. Charts of patients attending 3-, 4-, and 5-year well-child visits were randomly selected and reviewed for documentation of vision screening attempts, referrals, and need for rescreening.

Results:

Practitioners improved evidenced-based screening attempts for distance visual acuity and stereopsis of 3–5-year-old patients from 18% at baseline to 87% (P < 0.001) at 6 months; improved screening rates were sustained through completion of the collaborative. Baseline referral rates (26%) of abnormal vision screens improved by 59% (P < 0.001) during the first 6 months and were maintained through month 18. Rates for children with incomplete screens that were scheduled for a repeated screening increased during the first 6 months. However, changes in this metric did not reach statistical significance (P = 0.265), nor did it change during the remainder of the collaborative.

Conclusions:

Rapid integration and maintenance of preschool vision screening guidelines are feasible across primary care settings utilizing a structured learning collaborative. Challenges with the rescreening processes for children with incomplete vision screens remain, with the 3-year age group having the greatest room for improvement.

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<![CDATA[Impact of Integrating a Neonatal Early-Onset Sepsis Risk Calculator into the Electronic Health Record]]> https://www.researchpad.co/article/Nf1326103-c053-4cc9-829f-0372753dfd17

Introduction:

Investigators from Kaiser Permanente developed a risk-assessment calculator as a tool for evaluation of early-onset sepsis (EOS) to narrow antibiotic use for the treatment of EOS. The integration of the EOS risk calculator into an electronic health record will minimize manual calculations and data entry and improve compliance and accuracy through automation.

Methods:

We performed a retrospective chart review for neonates ≥34 weeks and 0 days gestational age. We collected data pre-integration and post-integration of the EOS risk calculator. The primary outcome measure is the accuracy of user input into the calculator. Secondary outcomes include compliance with using the EOS risk calculator, impact on clinical recommendation when incorrectly calculated, assessment of antibiotic utilization rate (AUR), and comparison of EOS risk calculator recommendations with Centers for Disease Control and American Academy of Pediatrics recommendations.

Results:

Miscalculations occurred in 52% of instances pre-integration and 19% of instances post-integration; P < 0.001. Compliance was 93% pre-integration and 98% post-integration; P = 0.138. Clinical recommendations were changed for 21% (13/62) of miscalculations pre-integration and 4% (1/23) of miscalculations post-integration; P = 0.099. The AUR for combined NICU and nursery patients was 47 pre-integration and 47 post-integration; P > 0.999. Six cases of culture-positive sepsis were identified, and all recommendations generated by the EOS risk calculator were in alignment with current Centers for Disease Control/American Academy of Pediatrics treatment guidelines.

Conclusions:

Integration of the EOS risk calculator into the electronic health record significantly increased calculator accuracy, although it did not show statistically significant differences with regards to compliance, clinical recommendations, or AUR.

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<![CDATA[Implementation of a Neonatal Audit Tool to Drive Quality Initiatives]]> https://www.researchpad.co/article/N7ddfe141-cab2-4cfa-bb37-2c10c469413c

Introduction:

Audit tools optimize the delivery of healthcare to patients. A network of 11 neonatal intensive care units (NICUs) affiliated with a large urban pediatric care institution implemented an audit tool for use on daily patient rounds. The article reports findings collected from 2011 to 2016.

Methods:

Primary drivers for implementation were (1) engagement from local providers; (2) identification of local improvement needs and improvement progress; (3) ability to customize audit questions based on local needs; (4) encouragement of information sharing between NICUs; and (5) improving measurable outcomes in neonatal care delivery. The Level IV NICU managed and refined a centralized process for managing site-specific tools, data analysis, and reporting. Each NICU customized the number and wording of action questions based on their needs. Answer choices were limited to “yes” or “no,” which corresponded to favorable or unfavorable actions toward the patient. Users also answered, “Was action taken as a result of an unfavorable response?”

Results:

Plan-Do-Study-Action cycles were completed to refine the tool and its implementation process. Adherence was variable among and within each network site. Across the network, 11.4% of actions tracked by the audit indicated improvement over time.

Conclusion:

Generalized use of the Audit Tool resulted in limited optimization of care actions addressed in the NICUs. Success depended on multi-disciplinary, multi-professional teamwork, respect for local autonomy, and leadership support. Increasing the use of the Audit Tool likely depends on the team’s ability to evolve the tool’s intrinsic value from a reminder to a monitoring system.

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<![CDATA[Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts]]> https://www.researchpad.co/article/5c2a76c0d5eed0c48422327d

Introduction:

This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children’s Health Insurance Program).

Methods:

Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).

Results:

Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02).

Conclusion:

Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.

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<![CDATA[Dissemination of a Novel Framework to Improve Blood Culture Use in Pediatric Critical Care]]> https://www.researchpad.co/article/5c2a76b3d5eed0c484222f71

Supplemental Digital Content is available in the text.

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<![CDATA[Surgical Safety Checklists in Children’s Surgery]]> https://www.researchpad.co/article/5c2a76c4d5eed0c48422335d

Supplemental Digital Content is available in the text.

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