These posters have been presented at meetings in Children's Mercy and around the world. They represent research that was done at the time they were created, and may not represent medical knowledge or practice as it exists at the time viewers access these posters.
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A NINJA Initiative at Children's Mercy
Richard Ogden, Bradley A. Warady, Vimal Chadha, and Wendy Hoebing
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An Innovation for Skin Integrity Risk Assessment SIRA Quality Metrics
Kristina Foster, Michele Fix, and Lacey Bergerhofer
Metrics for hospital acquired pressure ulcers over time, by stage, by device, and compared to other pediatric hospitals.
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A "Passport" to Urgent Care: Medical Student Education in the Pediatric Urgent Care Setting
Emily Montgomery, David Skoglund, Tiffany Addington, Robert Riss, and Amanda Montalbano
Background
Pediatric Urgent Care (PUC) serves as a rich environment to teach outpatient pediatric acute care. 96% of PUCs host trainees, but only 4% host medical students.1 Constraints on clinical teaching slots2 necessitate the utilization of novel settings.Fall 2017, the University of Kansas (KU) School of Medicine approached the Division of Urgent Care at Children’s Mercy Hospital (CMH) in Kansas City, Missouri to host 3rd year medical students as part of their pediatric clerkship.
The PUC became a new site for medical student education, necessitating the development of a new curriculum.
Objective
Create a curriculum for pediatric clerkship students in PUCAdvantages • High patient volume • Pediatric acute care problems
Challenges • Rapid patient turnover • Multiple student preceptorsSetting
Starting July 2018, two of the three CMH PUC sites host 3rd year KU medical students for two weeks of ambulatory care out of their 8-week pediatric clerkship.Design
Objectives were created through review of the Council on Medical Student Education in Pediatrics 3rd year objectives3 and KU pediatric clerkship objectives. We found multiple objectives could be met in PUC.Expectations: • Review website • Supervised procedures • Two notes per shift • Student-led teaching • Passport • Evaluations
Working with multiple preceptors, objectives were formatted into a “passport”. Medical students expected to demonstrate these objectives at the “shows how” level of Miller’s Pyramid.4
The Passport functions as a checklist to ensure the student receives a broad education on acute pediatric concerns. Topics that are not covered by patient encounters are covered through brief teaching sessions.
Discussion
The curriculum will be evaluated through post-rotation surveys of the rotation and all preceptors. The last 60 minutes of each student’s last shift are reserved for evaluation completion. Evaluations will be anonymously compiled and, once enough have been collected to ensure that anonymity, distributed to the preceptors and discussed with UC leadership.Conclusion
Medical students increasingly need more venues for hands-on education, and urgent care provides a unique opportunity to provide this education. As urgent care continues to grow as a field, it will become increasingly important to incorporate it into medical education. Our efforts represent the initial steps toward a goal of national urgent care education for medical students. Future work will include evaluation of how medical student education impacts patient turnover in urgent care and measuring student & preceptor satisfaction. -
Customizing a Pressure Injury Bundle Based on Unit-Specific Data
Kathlyn Baharaeen, Kimberly Palmer, Jamie Leroy, Julia Crouch, Bryan Limer, Gianna Swift, and Kate Gibbs
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Decreasing Cardiac Arrests in the Pediatric Intensive Care Unit
Jeremy Affolter, Kathlyn Baharaeen, Mari Hanson, Lisa Laddish, Amy Bohm, Lindsey Bradbury, Megan McGhee, Anne Leroy, Hannah Cunningham, Michelle Waddell, Tiffany Mullen, Kimberly Lucas, William Douglas, Angel Pope, Marita Thompson, Paul N. Bauer, Erica Molitor-Kirsch, Tara Benton, and Laura Miller-Smith
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Development of a Nurse Practitioner Newborn Hospitalist Service
Kristi Gordon, Elizabeth Simpson, Sarah Forge, and Eileen Almon
Background/Problem
•In 2012, our hospital expanded obstetrical services resulting in the delivery over 3700 infants per year.
•Approximately 35% of these infants had no relationship to a primary care physician with privileges at our hospital.
•These infants were either uninsured, Medicaid insured or privately insured but whose primary care physician did not have hospital privileges.
•Private Pediatricians “on call” were given these unassigned infants and were attempting to evaluate infants in the mornings, prior to seeing their scheduled office patients
•This resulted in an unmanageable daily census for them.
•This led to Pediatrician dissatisfaction, delayed medical evaluations of some infants, discharge planning dilemmas and financial burdens to both the hospital and the Pediatricians on staff.Project Description
•The existing affiliation with an Academic Children’s Hospital for Neonatology Professional and Neonatal Intensive Care Directorship services was expanded to include an Advanced Practice Registered Nurse (APRN) Newborn Hospitalist service to care for unassigned, routine newborns. Oversight was provided by physicians within the Division of Neonatology dedicated to coverage for this service.
Newborn Hospitalist Role
•Newborn hospitalists:
•Provide care to infants born at the delivery center whose primary care providers are not on staff.
•Dedicate 100% professional effort on newborns outside of intensive care setting. •Recent QI projects:
•Improving testing for drugs of abuse.
•Implementation of transcutaneous monitoring of bilirubin.
•Refining car seat testing guidelines.
•The team is currently preparing the first edition of a newsletter, Newborn Connections.Evaluations/Implications
•Consistent, timely medical evaluation of all infants without consideration of insurance/Physician availability or limitations.
•Safe, comprehensive, quality care for all infants without need for Private Pediatrician oversight.
•High family satisfaction ratings on patient satisfaction survey. •Small number of dedicated APRN Providers led to standardized education and care for families. •Consistent availability of services improved communication with nursing staff and hospital administrative staff.
•Improved discharge coordination with scheduled PCP follow-up appointments prior to hospital discharge.
•Affiliation with local Academic Center/Neonatology, improved credibility with families and seamless transition between NICU and routine newborn services. •APRN job satisfaction/career growth opportunities with autonomy building hospitalist service and coordination with supervisory physiciansConclusion
•In our state, development and growth of an APRN -led Newborn Hospitalist Service has permitted a population of infants to receive consistent, safe, quality care.
•This program could be duplicated at institutions with similar circumstances -
Financial Stewardship Through Appropriate Critical Care Documentation
Shobhit Jain, Nirav Shastri, Gregory P. Conners, and Irene Walsh
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Global Health Elective, Santiago, Dominican Republic, March 2018
July K. Jean Cuevas
Describes a global health learning experience to improve the knowledge of health care professionals and families about common developmental conditions, autism and ADHD.
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Impact of Huddles on Provider’s Knowledge of Medically Complex Patients
Irina G. Trifonova, Troy E. Richardson, Jessica L. Bettenhausen, and Matthew B. Johnson
Background:
The increasing complexity of pediatric inpatients requires that all providers understand a comprehensive child’s medical and social needs. A survey administered to Children’s Mercy Hospital inpatient providers identified gaps in knowledge regarding the daily plan of care and discharge planning needs among Complex Chronic Care (CCC) patients. Multidisciplinary rounds (MDRs) create a shared decision model among all team members to ensure that all aspects of care for CCC patients are addressed.Objectives:
To improve provider knowledge of the plan of care and discharge planning needs for CCC patients admitted to the Hospitalist service, from 40% to 75% of providers by implementation of MDRs.
Methods:
All CCC patients (defined by ICD-10 code diagnosis; Fuedtner, et. al.) admitted to the Hospitalist service were candidates for MDRs. Patients with CCCs on resident teaching service were excluded. MDR team included a hospitalist, bedside nurse, nurse care manager, social worker, pharmacist and nutritionist. Providers were notified of qualified patients for MDRs three times a week prior to rounds. The MDR team members discuss the medical plan, address medication change, nutrition status, social and discharge needs. The process measure included the frequency of provider’s attendance at MDRs; the time spent rounding per patient was the balancing measure. Pre-round huddles were implemented 6/1/2017 to facilitate discussion of CCC patients among team members unable to attend bedside rounds (Figure 1). Statistical process control charts were used to assess the impact of pre-round huddles on percent provider attendance at MDRs. Following implementation of MDRs, providers completed subsequent surveys reflecting their knowledge on the plan of care for CCC patients.Results:
MDRs were implemented 8/1/2016. Attendance remained unchanged until the introduction of pre-round huddles which significantly improved provider attendance (pConclusions:
Implementation of the pre-round huddles had the most impact on providers’ attendance at MDRs, without increase the rounding time per patient. While providers reported some improvement in understanding of care for CCC patients, the impact of provider attendance at MDRs or pre-round huddles on readmission rate of CCC patients remains to be determined. -
Implementation of Bedside Huddle to Improve Communication When Coordinating Care for PICU Patients with Newly Diagnosed Anterior Mediastinal Masses
Laura McCarthy, Pam Nicklaus, Paul Sheeran, Tara Benton, Jenna Miller, Douglas C. Rivard, Melissa Gener, Susan Whitney, and Keith August
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Implementing Lean Daily Management System to Improve CVOR First Case On-Time Starts
Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, and Kenneth Sam
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Improving Handoffs by Incorporating a Standardized IPASS Section Into the Written Handoff Document
Kristin Streiler and Susamita Kesh
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Improving HPV Immunization by Age 13 in Over 20 Kansas City Pediatric Practices
Luke A. Harris and Douglas Blowey
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Improving Pneumococcal Polysaccharide Vaccination in Children With Cystic Fibrosis
Adam Van Mason, Wendy Estrellado-Cruz, Kristi Williams, Ellen Meier, Elizabeth Elson, Stephanie Duehlmeyer, Paula Capel, Jessica Banks, and Christopher M. Oermann
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Increasing the Use of Waveform Capnography in Neonatal and Pediatric Patients
Sherry McCool, Lisa Pruitt, and Olivia Kaullen
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Incredible Years (IY) Parents & Babies Well-Baby Program: Expanding the Reach through Cultural Adaptation
Ayanda Chakawa and Briana Woods-Jaeger
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Knowledge Base of Adolescents with Congenital Heart Disease
Pamela Finn, Mark Gelatt, Jennifer A. Marshall, Jennifer Panuco, and Jenea Schmidt
Introduction:
Most congenital heart disease [CHD] is diagnosed and treated in early childhood in designated children’s hospitals with parents responsible for decision-making and receipt of information. The adolescent assumes this role in preparation for transition to an adult congenital heart program. We studied the knowledge base of our adolescent CHD patients and their parents.
Methods:
Established patients with CHD, >11 y.o. and their parents, were independently surveyed in the outpatient clinic prior to being seen over a one-year period. Participation was voluntary. Cardiomyopathy, transplant and electrophysiology patients were excluded. Scores were assessed as full, partial or incomplete.
Results:
Most (98% parents; 83% adolescents) reported that their cardiologist had provided education. Adolescents provided a full (49%) and partial (15%) medical name and full (32%) and partial (35%) description of their condition. Older adolescents performed better (p<0.005). Parents scored better, regardless of patient age (p<0.005). Patients undergoing last surgery >11 y.o. scored better than those with surgery only when younger or without surgery (p<0.05). Patients with mild unrepaired or surgically repaired shunt lesions (ASD, VSD, PDA), and their parents, were much less able to name their lesion than those with left heart lesions (aortic stenosis, coarctation, mitral valve disease), tetralogy of Fallot, TGA/TAPVR or palliated single ventricles, but similar in ability to at least partially describe the defect (p<0.005). In this more affected population, the ability to fully name the defect (81/134; 60%) far exceeded the ability to fully describe it (37/134; 28%; p<0.005). Patients with complex lesions were more likely to report effect on exercise ability, work and recreation.
Conclusion:
Less than one-half of adolescents are able to name their cardiac defect, and one-third are able to adequately describe the anatomy. Older adolescents, those with a more recent history of surgery and those with more complex defects perform better. A stronger emphasis should be placed on educating and preparing adolescents and young adults earlier and over many years regardless of complexity of CHD.
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Leveraging Human Factors to Improve CLABSI: Implementation of a Central Line Dressing Change Kit
Tara Benton, Barb Haney, Lacey Bergerhofer, Susan Burns, Yolanda Ballam, and Kaitlyn Hoch
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Medication Timeliness in Emergency Department in Pediatric Sickle Cell Disease Population Presenting with Vaso-Occlusive Episode
Derrick Goubeaux, Kaitlyn Hoch, Gerald Woods, Julie Routhieaux, Maureen Guignon, and Valerie McDougall Kestner
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More Timely Care: Effect of Online Queuing System vs. Change in Hours of Operation on Hourly Arrival Volumes
Aimy Patel, Brian R. Lee, and Amanda Montalbano
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Partnering with Inpatient Situation Awareness Screening to Improve Early Sepsis Recognition
Leslie Hueschen, Stephanie Burrus, Andrea Raymond, Charity Thompson, Lisa Carney, and Jay Rilinger
Background
Early recognition of sepsis and designing a huddle process are key drivers of the Improving Pediatric Sepsis Outcomes (IPSO) collaborative. Our tertiary care, free-standing, pediatric hospital joined the IPSO collaboration in 2016. Our hospital began piloting Situation Awareness (SA) Escalation Huddles in 2016, to improve recognition of patients with clinical deterioration. The tool triggers if a patient has a high PEWS(> 5), requires initiation of hi-flow nasal cannula, or for staff/parental concern. The SA paper tool guides the communication process and steps of the huddle. Huddles include a nurse, provider, and respiratory therapist. One of the goals of the SA escalation huddle is to decrease the amount of Advanced Life Support code blue events and rapidly identify sepsis patients on the inpatient units. Prior to this study there was no formal screening process for sepsis in the inpatient units.
Objective
•Identify septic patients early on inpatient units by forcing consideration of sepsis during SA screening in high-risk patients. •Utilize existing SA screening tool without employing increased work demands on care providers. •Ultimately, improve timely treatment of septic patients (antibiotics, fluid resuscitation) and escalate to higher level of care earlier, if indicated.
MethodsIn Fall 2017, a question “Sepsis Concern?” was added to the SA tool to better identify septic patients. Roll out of new SA tool was completed in a step-wise process throughout the hospital and completed January 2018 in all units. We collected the number of PICU transfers with + SA tool. We hypothesized this change should lead to timely identification of sepsis, care team huddle with bedside discussion, treatment, and escalation of care. Sepsis clinical practice guidelines and order-sets were developed in conjunction to aid in the decision making process.
Results
There were 162 number of severe sepsis patients treated from September 2017 to March 2018 in our hospital. There were an average of 23 severe sepsis patients each month. 21% (34/162) of these patients were identified to have possible sepsis on the inpatient units.From September 2017 to March 2018, 1,012 SA tools were triggered with a mean of 4.8 huddles/day. The average patient had an average 2.3 (1,012/445) SA huddles during their hospitalization. Of SA triggers, 49 huddles (over 34 patients) screened positive for “Sepsis Concern?”(4.8%,49/1,012). 71% of “+ Sepsis Concern” episodes were treated as possible severe sepsis (35/49). Of the “+ sepsis concern” patients, 29% (10/34) were transferred to the ICU. When completing the SA form 13.3% (135/1,012) skipped the “Sepsis Concern?” question.
During the study, 21% of PICU transfers for possible severe sepsis had the SA tool used (3/14) prior to transfer.
ConclusionsThe majority of sepsis patients identified with the SA tool had severe sepsis and required ICU care. Ideally the “concern for sepsis” question would generate a shared mental model in the diagnosis and treatment of sepsis, however even questioning the possibility of sepsis and discussion about sepsis remains challenging.
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Peer Accountability Improves Performance for Daily CHG Bathing to Reduce CLABSIs
Sara Crawford, Stacy Pennington, Jeremy Affolter, Kathlyn Baharaeen, Paul N. Bauer, Tara Benton, Shekinah Hensley, Tiffany Mullen, and Michelle Waddell
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Pharmacy Driven Best Possible Admission Medication History at a Pediatric Institution
Damon Pabst, Charity Thompson, Brandon French, Brian O'Neal, Garret Matthews, Zeb Benner, and Joshua Meade
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Pressure Injury Prevention for Urology Surgical Procedures: A QI Initiative
Azadeh Wickham, Pat Clay, and Kate Gibbs
