Quality Corner

May 31, 2019 by

UVA Children’s Hospital Quality Update
by Dr. Jonathan Swanson

Data. When it comes to quality improvement, data mean everything. Without it, the clinical team would have an extraordinarily difficult time deciding on what to focus on or what opportunities for improvement were available. I’m not a chef, but I consider QI work without data much like someone trying to bake a cake without knowing how much flour, sugar, milk and eggs to use – extremely difficult (or next to impossible)!  It’s also the reason why anyone who is asks about starting a QI project, I urge them to start collecting some data as soon as possible.

Knowing that there are only 24 hours in a day and everyone has multiple responsibilities, the Women’s & Children’s Service Line has a couple of people that can help with generating data. Stephen Simmers is the service line’s data analyst and Michael Heinze is a data analyst assigned to the service line who works for the Quality & Performance Improvement Department. Both of these data gurus can help generate some initial data when trying to start a project. Please reach out to see how they might be able to help if you are stuck!

Another option for automated data generation is Epic itself. With a little-known tool called Slicer Dicer, you can explore your own data or that of a specific population. Examples include comparing this year’s number of patients who received the flu shot to last year’s numbers or seeing what percentage of your patients have a diagnosis of asthma and went to the Emergency Department. Slicer Dicer takes a little getting used-to, so play around with it to see how it may help you in your QI project. To get to Slicer Dicer, type “Slicer” in the Epic Search Bar (top right corner of the Epic platform).

Finally, the Children’s Hospital is investing in more registries to help drive improvement. The NICU has been a part of Vermont Oxford Network (VON) for over a decade and the Heart Program is a member of the Society for Thoracic Surgeons Public Reporting database. Both of these groups have allowed the programs to benchmark themselves to similar institutions and look for areas for improvement. For example, in 2016, the NICU noticed an uptick in severe intraventricular hemorrhage and found that the rate of nearly 16% was well-above the national average. A multidisciplinary team worked together to create an IVH-reduction bundle and dropped the rate to 8%, below the national average. Similarly, the Congenital Heart Disease Program have used STS data to drive improvements in survival by evaluating care processes from pre-operation to discharge. Observed operative mortality was 2.1% in 2018, well below the expected mortality rate of 3.6%.

Other registries that the Children’s Hospital is a part of include:

  • Improve Care Now – gastroenterology
  • Pediatric Cardiac Critical Care Collaborative – cardiology & critical care
  • Pediatric Acute Care Cardiology – cardiology
  • American College of Surgeons – NSQIP – pediatric surgery & surgical subspecialties

More recently, the Children’s Hospital joined Solutions for Patient Safety. This will allow us to benchmark our inpatient care to the vast majority of children’s hospitals across the country. Data will be submitted for events such as unplanned extubations, readmissions, CLABSI/CAUTI, pressure ulcers, acute kidney injury and several others. More information on SPS here.

No matter where you are on your QI journey, just remember that without data, it is unlikely that you will be going anywhere quickly.

Check out these links:

Congratulations Orange Pediatrics! Orange Pediatrics is the first Department of Pediatrics clinic to achieve a designation as a Patient-Centered Medical Home (PCMH).  This was a great deal of hard work and multiple quality improvement projects that led to this recognition.

UVA earns an “A” on Leapfrog Leapfrog Hospital Safety Grade is used by several national and regional health plans and vendors to educate patients on the importance of choosing a safe hospital. UVA raised their grade to an A over several years through Be Safe.

Filed Under: Features