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Quality Improvement

A Blueprint for Better Care: The Constant Drive for Quality Improvement in Primary Care
 A Blueprint for Better Care: The Constant Drive for Quality Improvement in Primary Care 1024 683 Alaina London
By: Alaina London
A smiling girl sits on a table at a doctor's office. A smiling female doctor is checking the girl's ear.

A culture of quality improvement at Nationwide Children’s Hospital has become the model of care for children across the country. Every day, thousands of children walk through the doors of Nationwide Children’s Primary Care Centers for well visits, follow-up care, acute illness and so much more. Across 14 primary care sites where more than 150,000…

Improving Neonatal X-Ray Quality Through Standardization
 Improving Neonatal X-Ray Quality Through Standardization 1024 683 Pam Georgiana
By: Pam Georgiana
Baby in a NICU bed with nasal canula. Swaddled in white blanket with health care worker's hand gently resting on the baby.

Pre-X-ray Safety CHECK reduces repeat imaging, radiation exposure and diagnostic variability in the NICU. Portable radiographs are necessary for diagnosing disease and evaluating position of medical devices in neonatal intensive care units (NICUs). However, repeat imaging due to poor-quality radiographs exposes vulnerable infants to additional radiation and unnecessary handling, disrupting their environment and potentially compromising…

Better Asthma Outcomes: A Systems-Level Approach
 Better Asthma Outcomes: A Systems-Level Approach 1024 422 Katie Brind'Amour, PhD, MS, CHES
By: Katie Brind'Amour, PhD, MS, CHES
Smiling child wearing a blue bike helmet and vest while riding outdoors on a sunny day, promoting bicycle safety and healthy outdoor activities for kids.

A dedicated team of experts embraced sweeping tactics to reduce asthma-related emergency department visits by 33% and inpatient length of stay by 0.9 days. This is how they did it. It started with a conversation about the data: Why are kids with asthma the hospital’s most frequent fliers? After all, excellent preventive and acute treatments…

Optimizing Outpatient Epilepsy Care With Digital Seizure Action Plans
 Optimizing Outpatient Epilepsy Care With Digital Seizure Action Plans 1024 683 Pam Georgiana
By: Pam Georgiana

Customized seizure action plans enhance care and family use. Many schools and caregivers require families of children with epilepsy to provide a written seizure action plan (SAP) signed by their primary care provider. The Epilepsy Foundation provides a printable PDF form to fill out, print and sign. However, the form is limited in providing space…

Quality Improvement Approach Reduces Pediatric Asthma Emergency Department Visits by 33%
 Quality Improvement Approach Reduces Pediatric Asthma Emergency Department Visits by 33% 770 513 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM

With institutional support, a primary care-based quality improvement initiative markedly reduced asthma-related emergency department visits for children with asthma. Researchers at Nationwide Children’s Hospital implemented a quality improvement (QI) project that reduced pediatric asthma emergency department (ED) visits by 33% from 2010 to 2019. Stephen Hersey, MD, a pediatrician in Nationwide Children’s section of primary…

Increasing Same-Day Amoxicillin Graded Dose Challenges
 Increasing Same-Day Amoxicillin Graded Dose Challenges 1024 683 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM

A quality improvement initiative overcomes several barriers to de-labeling penicillin allergies. In a study published in The Journal of Allergy and Clinical Immunology: In Practice, a research team led by Margaret Redmond, MD, a pediatric allergist at Nationwide Children’s Hospital, reported on a quality improvement (QI) initiative that sustainably increased rates of same-day amoxicillin graded…

Improving Outcomes for Infants and Children With Congenital Hypothyroidism
 Improving Outcomes for Infants and Children With Congenital Hypothyroidism 1024 575 Mary Bates, PhD
By: Mary Bates, PhD
Photo of a toddler playing with toys

A quality improvement project identifies high-risk patients and ensures they receive necessary care.   Congenital hypothyroidism (CH) is one of the most common preventable causes of intellectual disability. In the United States and many other countries, newborns are tested a 24-72 hours after birth for CH as part of standard screening tests. This condition must…

Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures
 Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures 1024 682 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM
smiling baby being held up by an adult

To address the national opioid epidemic, clinician-scientists developed a quality improvement initiative to achieve significant, long-term reductions in opioid prescriptions after common pediatric urologic procedures.   Opioids are commonly prescribed for pediatric urologic procedures. However, studies have reported a troubling practice of overprescribing opioids in pediatric health, contributing to the ongoing opioid epidemic. “There is…

Quality Improvement in Primary Care Improves Dental Utilization and Oral Health Outcomes in Children
 Quality Improvement in Primary Care Improves Dental Utilization and Oral Health Outcomes in Children 1024 680 JoAnna Pendergrass, DVM
By: JoAnna Pendergrass, DVM
toddler brushing teeth

Quality improvement provides an effective, standardized approach to increasing pediatric dental utilization and improving oral health outcomes in primary care settings. According to a recent study by pediatric dentist David Danesh, DMD, MPH, MS, and his research team at Nationwide Children’s Hospital, children receiving fluoride varnish at medical practices with an oral health quality improvement…

Using Hormone Therapy First Drives Earlier Remission From Infantile Epileptic Spasms Syndrome
 Using Hormone Therapy First Drives Earlier Remission From Infantile Epileptic Spasms Syndrome 1024 575 Natalie Wilson
By: Natalie Wilson

Recent research conducted at Nationwide Children’s Hospital demonstrated standardizing hormone therapy as the first treatment for infantile spasms improved rates of early remission. Infantile epileptic spasms syndrome (IESS) is an uncommon epilepsy syndrome characterized by seizures called infantile spasms that begin between 1 and 24 months of age (with a peak age of onset at…

Quality Improvement Scorecard Enhances Safety for Newborns
 Quality Improvement Scorecard Enhances Safety for Newborns 1024 683 Emily Siebenmorgen
By: Emily Siebenmorgen

The collaborative program between academic and community hospitals improves neonatal care quality. In a recent study published in The Journal of Pediatrics, researchers from Nationwide Children’s Hospital and affiliated level one and two community hospital nurseries implemented a quality improvement (QI) scorecard and found improvements in important perinatal outcomes. “Roughly half of all newborns in…

Reinforcing Education for Adrenal Insufficiency Self-Management Improves Patient Outcomes
 Reinforcing Education for Adrenal Insufficiency Self-Management Improves Patient Outcomes 150 150 Lauren Dembeck
By: Lauren Dembeck

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…

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
By: JoAnna Pendergrass, DVM
Julie Samora, MD

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…

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
By: Katie Brind'Amour, PhD, MS, CHES
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…

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
By: John Barnard, MD
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,…

New Celiac Care Index Improves Adherence to Care Guidelines
 New Celiac Care Index Improves Adherence to Care Guidelines 1024 575 Lauren Dembeck
By: Lauren Dembeck
Two girls at a park holding each other smiling

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.…

From Clinician Ideas to Commercially-Available Clinical Devices
 From Clinician Ideas to Commercially-Available Clinical Devices 150 150 Kevin Mayhood
By: Kevin Mayhood

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…

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
By: Jan Arthur

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…

Stopping Progression of Tissue Injury after Button Battery Ingestion
 Stopping Progression of Tissue Injury after Button Battery Ingestion 150 150 Abbie Miller
By: Abbie Miller

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…

“Learn From Every Patient” to Improve Clinical Care
 “Learn From Every Patient” to Improve Clinical Care 150 150 Lauren Dembeck
By: Lauren Dembeck

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…

Using Quality Improvement to Customize Opioid Reduction Strategies
 Using Quality Improvement to Customize Opioid Reduction Strategies 1024 681 Abbie Miller
By: Abbie Miller
Close up image of white tablets spilling out of a prescription bottle

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…

Moving From Child Health Care to Child Health
 Moving From Child Health Care to Child Health 1024 683 Kelly Kelleher, MD, MPH
By: Kelly Kelleher, MD, MPH
Dr. Kelly J. Kelleher, MD

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…

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
By: Aimee Swartz, MPH

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…

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 Miller
By: Abbie Miller
A young boy looking at a doctor smiling while the woman in a white coat uses a stethoscope to evaluate the patient

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…

Improving Feeding and Growth in Children With Cleft Palate
 Improving Feeding and Growth in Children With Cleft Palate 1024 684 Mary Bates, PhD
By: Mary Bates, PhD
Image of a hand hovering above an infant formula bottle with a measuring spoon filled with powdered formula

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…

Weaving an Antimicrobial Safety Net
 Weaving an Antimicrobial Safety Net 150 150 Kevin Mayhood
By: Kevin Mayhood

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…

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
By: Kevin Mayhood
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…

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
By: Kevin Mayhood

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…

Care Bundles Can Reduce Hospital-Acquired Pressure Injuries
 Care Bundles Can Reduce Hospital-Acquired Pressure Injuries 150 150 Brianne Moore
By: Brianne Moore

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)…

Speedy Development of Support Programs for Second Victims Demands Collaboration
 Speedy Development of Support Programs for Second Victims Demands Collaboration 150 150 John Hofmeister
By: John Hofmeister

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…

How to Improve Apparent Cause Analyses and Reduce Error Recurrence
 How to Improve Apparent Cause Analyses and Reduce Error Recurrence 150 150 Brianne Moore
By: Brianne Moore

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…

Combining Quality Measures to Improve Surgical Outcomes
 Combining Quality Measures to Improve Surgical Outcomes 150 150 Kevin Mayhood
By: Kevin Mayhood

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.…

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
By: Brianne Moore

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…

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
By: Kevin Mayhood

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…

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
By: Jeb Phillips

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…

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
By: Jan Arthur

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…

Data-Driven Health Care Delivery
 Data-Driven Health Care Delivery 150 150 Tiasha Letostak, PhD
By: Tiasha Letostak, PhD

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…