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Quality Improvement

Reinforcing Education for Adrenal Insufficiency Self-Management Improves Patient Outcomes
 Reinforcing Education for Adrenal Insufficiency Self-Management Improves Patient Outcomes 150 150 Lauren Dembeck
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Patients with adrenal insufficiency (AI) receiving daily maintenance corticosteroid replacement therapy may develop signs and symptoms of AI when encountered with physical stress events, such as fever, infection, pain from injury or surgery. Patient education on stress dosing of hydrocortisone at the time of illness or injury is essential to prevent adrenal crisis, a life-threatening…

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Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery
 Reducing Opioid-Induced Constipation in Patients After Orthopedic Spine Surgery 1024 575 JoAnna Pendergrass, DVM
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In pediatric patients undergoing orthopedic spine surgery, a step-wise bowel management plan can effectively reduce opioid-induced constipation and unplanned emergency department visits after surgery. Orthopedic spine surgery can generate pain in the immediate post-surgery period. Opioids are needed to mitigate this pain but commonly cause constipation and other gastrointestinal side effects. Opioid-induced constipation causes abdominal…

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Comprehensive Type 1 Diabetes Wellness Score to Help Patients and Providers
 Comprehensive Type 1 Diabetes Wellness Score to Help Patients and Providers 1024 683 Katie Brind'Amour, PhD, MS, CHES
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Device for monitoring glucose placed on girl's arm

A quality improvement effort resulted in the first-known composite score to track multiple clinical indicators of diabetes-related health in patients with Type 1. Despite the traditional use of hemoglobin A1c (HbA1c) as the standard metric for diabetes control, it has its shortcomings, such as an incomplete picture of blood sugar variability and hypoglycemia risk. To…

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Obsessed with Zero: Reflections on the Career and Achievements of Richard J. Brili, MD
 Obsessed with Zero: Reflections on the Career and Achievements of Richard J. Brili, MD 1024 575 John Barnard, MD
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Richard J. Brilli, MD

In 2008, Richard “Rich” Brilli, MD, was recruited to Nationwide Children’s Hospital as its chief medical officer. Among other physician executive duties, he was charged with lowering the rate of preventable harm as leader of the hospital’s quality and safety programs. After a few months of learning about our organization’s culture and assessing our potential,…

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New Celiac Care Index Improves Adherence to Care Guidelines
 New Celiac Care Index Improves Adherence to Care Guidelines 1024 575 Lauren Dembeck
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The recent implementation of a Celiac Care Index (CCI) at Nationwide Children’s Hospital resulted in improved adherence to published care guidelines, reduced variability in baseline evaluations, and indicated potentially unnecessary baseline laboratory tests for further evaluation. The study, which was published in The Journal of Pediatrics, describes the quality improvement (QI) strategy implemented at the hospital.…

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From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
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Pressure wounds were a common complication following a tracheostomy, often resulting in advanced-stage wounds, national studies showed. Nationwide Children’s Hospital was no different but Kris Jatana, MD, and Charles Elmaraghy, MD, surgeons in the Department of Otolaryngology, knew they could improve these outcomes. Brendan Boyle, MD, and Alex Green, DO, were fellows in the Division…

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Predicting Acute Health Care Utilization in Patients with Pediatric Type 1 Diabetes
 Predicting Acute Health Care Utilization in Patients with Pediatric Type 1 Diabetes 150 150 Jan Arthur
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Study demonstrates the utility of a high risk assessment screening tool in differentiating between patients with versus patients without any acute health care utilization. The multidisciplinary Quality Improvement Team in the Section of Endocrinology at Nationwide Children’s Hospital, led by Manmohan Kamboj MD, FAAP, Division chief and section chief of Endocrinology, developed a brief risk screening…

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Stopping Progression of Tissue Injury after Button Battery Ingestion
 Stopping Progression of Tissue Injury after Button Battery Ingestion 150 150 Abbie Roth
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Irrigation with acetic acid neutralizes tissue and prevents delayed esophageal complications. Button battery injuries in children have been increasingly severe – resulting in devastating injuries and even death. Button batteries damage esophageal tissue through isothermic hydrolysis reactions, resulting in alkaline caustic injury, which leads to tissue necrosis. Prompt removal of the battery is critical to…

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“Learn From Every Patient” to Improve Clinical Care
 “Learn From Every Patient” to Improve Clinical Care 150 150 Lauren Dembeck
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How can busy clinicians tending to clinical care simultaneously conduct translational research and improve treatments for patients? The Nationwide Children’s Hospital Cerebral Palsy team recently reported an evidence-based change in practice — eliminating annual screening X-rays in patients mildly affected by CP — facilitated by use of the Learn From Every Patient (LFEP) Program. LFEP…

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Using Quality Improvement to Customize Opioid Reduction Strategies
 Using Quality Improvement to Customize Opioid Reduction Strategies 1024 681 Abbie Roth
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Different specialties across pediatrics have different uses, indications and practices when it comes to opioids. Many primary care pediatricians do not routinely prescribe them. Pediatric surgical specialties, however, may use opioid medications more frequently depending on the patient and procedure performed. While broad restrictions, such as those enacted on the federal and state levels, aimed…

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Moving From Child Health Care to Child Health
 Moving From Child Health Care to Child Health 1024 575 Kelly Kelleher, MD, MPH
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As pediatricians, we want children to be healthier, even the ones who never come through our doors. At Nationwide Children’s Hospital, the board and leadership have aimed to do just that by setting the highest bar yet for our organization – we want central Ohio children to be the healthiest in the United States. But…

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Quality Improvement Study Shifts HPV Vaccine Initiation to Earlier Age
 Quality Improvement Study Shifts HPV Vaccine Initiation to Earlier Age 150 150 Aimee Swartz, MPH
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A QI project shows that it is feasible, and possibly beneficial, to routinely administer HPV vaccine at age 9. It is feasible, and possibly beneficial, to routinely administer the human papillomavirus (HPV) vaccine beginning at age 9 — two to three years earlier than currently recommended — according to findings from a recent study conducted…

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QI Project Improves Response Time to Nurse Triage Phone Calls in Busy ENT Practice
 QI Project Improves Response Time to Nurse Triage Phone Calls in Busy ENT Practice 1024 683 Abbie Roth
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A high-volume pediatric otolaryngology practice receives a lot of phone calls from patients and families. The practice at Nationwide Children’s Hospital, which sees 32,000 clinic visits and 9,000 surgical patients each year, averaged more than 200 triage calls per week over the last 5 years. The response times to those calls needing clinician input ranged…

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Improving Feeding and Growth in Children With Cleft Palate
 Improving Feeding and Growth in Children With Cleft Palate 1024 575 Mary Bates, PhD
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Black and white photo of baby bottle with formula on the table in front of a simple background

Targeted interventions result in improved feeding efficiency and growth in infants with cleft lip and/or palate. Cleft lip and/or palate is a relatively common birth defect that occurs when certain parts of the face and mouth fail to fuse during development. Infants with the condition can struggle to suck or extract liquid from the breast…

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Weaving an Antimicrobial Safety Net
 Weaving an Antimicrobial Safety Net 150 150 Kevin Mayhood
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Stewards thread together monitoring programs and new protocols while trimming unwarranted tests and diagnostic speed. This story also appeared in the Spring/Summer 2018 print issue. Download a PDF of the print issue. Studies estimate that 30 to 50 percent of antimicrobials prescribed in hospitals and up to 50 percent prescribed in outpatient settings are either unnecessary…

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Quality Improvement Boosts Use of Enteral Therapy in Patients With Crohn’s Disease
 Quality Improvement Boosts Use of Enteral Therapy in Patients With Crohn’s Disease 1024 575 Kevin Mayhood
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Color image of enteral complete liquid nutritional products of several brands

Refined procedures, tools and support promote this proven alternative to steroids. A team of researchers found that employing quality-improvement methods increased use of exclusive enteral nutrition (EEN) to induce remission in children with Crohn’s disease at Nationwide Children’s Hospital. By increasing awareness of the therapy, standardizing procedures and providing support, EEN usage increased from less…

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A Different Way of Measuring Undesired Events Can Better Clinical Performance
 A Different Way of Measuring Undesired Events Can Better Clinical Performance 150 150 Kevin Mayhood
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Clinical care indexes allow departments to track failures and harm and continually upgrade processes for delivering optimal care. Three Nationwide Children’s Hospital departments that developed and applied their own clinical index to the care of patients with a certain illness or who underwent specific procedures, substantially improved their clinical performance. An index allows medical staff…

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Care Bundles Can Reduce Hospital-Acquired Pressure Injuries
 Care Bundles Can Reduce Hospital-Acquired Pressure Injuries 150 150 Brianne Moore
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Reliable implementation of care bundles reduces the number of serious hospital-acquired pressure injuries Hospital-acquired pressure injuries (PI) are a significant cause of preventable harm that can increase hospitalization costs and length of stay. Up to 27 percent of pediatric intensive care unit (PICU) patients and up to 23 percent of neonatal intensive care unit (NICU)…

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Speedy Development of Support Programs for Second Victims Demands Collaboration
 Speedy Development of Support Programs for Second Victims Demands Collaboration 150 150 John Hofmeister
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Openly sharing research and resources results in rapid development and growth of peer program for health care workers experiencing second victim phenomena. A career in health care brings many rewards — but it also puts its practitioners at risk for depression, anxiety, shame or career burnout whenever a medical error occurs or a patient experiences…

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How to Improve Apparent Cause Analyses and Reduce Error Recurrence
 How to Improve Apparent Cause Analyses and Reduce Error Recurrence 150 150 Brianne Moore
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A quality improvement team embarks on a project focused on the accuracy of future quality improvement initiatives. An apparent cause analysis (ACA) is a process used to investigate the cause or causes of a medium or low-risk safety event. Designed as a quality improvement measure, ACAs are used to explain in detail why an issue…

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Combining Quality Measures to Improve Surgical Outcomes
 Combining Quality Measures to Improve Surgical Outcomes 150 150 Kevin Mayhood
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Use a refined morbidity and mortality conference with a national database, a new study suggests. A pediatric surgery morbidity and mortality (M&M) conference that applies quality improvement practices borrowed from industry can be a significantly more effective tool for learning from mistakes and making corrections, researchers from Nationwide Children’s Hospital show in a new study.…

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Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures
 Meaningful Improvement of Child Health Requires Core Quality and Outcomes Measures 150 150 Brianne Moore
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The seemingly infinite indicators large pediatric systems use to measure children’s health often fall short in determining patient outcomes and quality of care. In an editorial published in JAMA Pediatrics, Kelly Kelleher, MD, director of the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital, and co-author William Gardner from the Children’s Hospital of Eastern Ontario, call for…

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How a QI Intervention Lowered Breast Milk Errors in a Busy NICU
 How a QI Intervention Lowered Breast Milk Errors in a Busy NICU 150 150 Kevin Mayhood
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Bedside barcode scanners and dedicated milk preparation technicians helped drive the decline. A quality improvement (QI) initiative in the Neonatal Intensive Care Unit (NICU) at Nationwide Children’s Hospital has been associated with a substantial reduction in errors administering mother’s milk to these vulnerable infants. The total number of scanned errors declined from 97.1 per 1,000…

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How a QI Project Dramatically Increased Pediatric Survival After Cardiopulmonary Arrest
 How a QI Project Dramatically Increased Pediatric Survival After Cardiopulmonary Arrest 150 150 Jeb Phillips
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A survival rate of 37-48 percent among young heart surgery patients who experience code events is the norm. A multidisciplinary review process helped achieve an 81 percent rate at Nationwide Children’s Hospital. Survival rates have remained stubbornly low for young heart surgery patients who experience cardiopulmonary arrest; critical care literature reports that fewer than 50…

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Local Learning Health System Model Demonstrates High-Quality Patient Care While Reducing Costs
 Local Learning Health System Model Demonstrates High-Quality Patient Care While Reducing Costs 150 150 Jan Arthur
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Providing high-quality patient care while reducing costs is a significant goal in the current health care reform environment. The Institute of Medicine has specifically called for the establishment of “learning health systems” to address this challenge. In a learning health system, the electronic health record is utilized to drive research and personalized treatments based on…

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Data-Driven Health Care Delivery
 Data-Driven Health Care Delivery 150 150 Tiasha Letostak, PhD
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Health care enterprise data warehouse (EDW) technology, analytics and cross-functional teams are leading to improved quality and efficiency of patient care. Big data has big potential, but despite the value of electronic health record (EHR) systems in digitizing care at hospitals, data-driven improvements are commonly hindered by an inability to measure and analyze this data…

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