Trainees Improving Care in the Children’s Hospital
The national organization that oversees residency training programs (Resident Review Committee of the Accreditation Council of Graduate Medical Education) requires that pediatric residents and fellows learn quality improvement methods and participate in a QI project during the residency and/or fellowship. With the implementation of Be Safe across the Children’s Hospital last Fall, there have been a number of projects and issues where residents and fellows have been involved. In this month’s Quality Corner, we will highlight two of these projects.
Development of a Standardized Sepsis Alert Protocol
Drs. Zachary Coffman and Matthew McGraw (Pediatric Residents)
Drs. Coffman and McGraw, with the mentorship of Dr. Lynn McDaniel and a diverse multidisciplinary team, have been evaluating our current ability to respond to patients when there is a concern for sepsis. They recently presented their baseline analysis of at-risk populations at the Birdsong Conference. In evaluating high-risk patients (neutropenic oncology patients, sickle cell patients, and infants < 90 days of age) that were admitted in 2013 and 2014 with fever or sepsis concerns, the team found that it took an average of 30-45 minutes before a blood culture order was placed, 55-100 minutes to draw a blood culture, and 99-188 minutes for antibiotics to be administered (all times after the first set of recorded vital signs). Our goal (and the national standard) is to have antibiotics administered within one hour of documented concerns of sepsis. The Children’s Hospital has a long way to go, but this multidisciplinary team has already been hard at work to improve this quality measure. In the next few weeks, the Children’s Hospital will implement a Pediatric Sepsis Alert Protocol to ensure these high-risk patients get the treatment they need in a timely manner. The protocol will include Epic Best Practice Advisories, pharmacy involvement, and will be used by all pediatric care providers on the acute care wards. More information will be coming soon – so stay tuned!
Improving Admission Temperatures in Premature Neonates
Dr. Matthew Harer (Neonatology Fellow)
Dr. Harer, with the mentorship of Dr. Brooke Vergales, has led a multidisciplinary team including our Obstetrical colleagues, to improve the rates of low admission temperatures (hypothermia) in premature infants admitted to the NICU. In 2014, over 70% of premature infants < 35 weeks’ gestation were admitted with a temperature lower than desired (36.5 °C) and only 25% were in the desired range (36.5-37.5°C), rates well below national benchmarks. After implementing a pilot guideline that increased operating room temperatures, established a protocol to use thermal mattresses for infants < 35 weeks and a polyethylene wrap for infants < 28 weeks. After this implementation, the rate of hypothermia fell to 38% and normothermia increased to 58%. This team continues to use the Plan-Do-Study-Act (PDSA) method to adjust and fine-tune the protocol to enhance the improvement in admission temperatures.
Children’s Hospital “Big 6” – Patient Harm
As a follow-up to last month’s article on the “Big 6,” here is the current data on patient harm. Let’s continue to work towards making the Children’s Hospital the safest place to work and the safest place to receive care!
| Month | CLABSI | CAUTI | HAPU | Falls | TM Injury |
|---|---|---|---|---|---|
| January | 3 | 0 | 0 | 0 | 3 |
| February | 2 | 1 | 0 | 2 | 10 |
| March | 1 | 0 | 0 | 0 | 8 |
| April | 1 | 0 | 0 | 0 | 0 |
| Year to Date | 7 | 1 | 0 | 2 | 21 |
*Data as of April 26, 2015
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