Standardizing the transfer criteria and implementation of a transfer-readiness assessment reduced the time-to-transfer decision out of the PICU from 14.4 hours to 7.8 hours and increased the proportion of patients transferred on >/6Lpm of HHF oxygen in children with viral bronchiolitis. No increase in PICU readmissions or use of rapid response team was found.
IHQSE leader Dr. Tyler Anstett and colleagues report on how a systems-based M&M conference with key stakeholders present resulted in significant improvements in completion time of ‘routine’ (18-minute reduction) and ‘now’ (8-minute reduction) ordered inpatient electrocardiograms. This is the first study to show a positive impact on a process following a systems-based case review conference.
Alumni of IHQSE’s Certificate Training Program publish outcomes resulting from a series of interventions aimed at improving adherence with recommended well-child checks and continuity of care with the same provider in the first year of a child’s life. Using the medical home concept as a guide, this team’s program showed increased adherence with first five visits in the first year of life from 25% to 78% with sustained improvement in subsequent years.
IHQSE Faculty, Dr. Sarah Tevis and team, published findings of a study which assessed opioid prescribing preferences for acute postoperative pain. Surgical residents reported that faculty preferences for opioid prescribing are a significant driver in their prescribing practices, inadvertently resulting in variability from established prescribing guidelines. Surgeons were surveyed about their preferences for prescribing opioids; those responses were then compared with actual prescribing practices and prescribing guidelines determined by the Opioid Prescribing Engagement Network. Results of the survey suggest that there is a disconnect in communication between residents and faculty as well as opportunity for enhanced education on prescribing guidelines.
IHQSE Faculty, Dr. Sarah Tevis, co-authored a study showing that lumpectomy patients who received a perioperative opioid-sparing multimodal analgesia protocol reported significantly lower postoperative pain and were able to be discharged without an opioid prescription. This publication in Annals of Surgical Oncology showed the reduction of excess opioids available for diversion--made possible by implementing opioid-sparing multimodal analgesia.
Working with a team of clinicians and informaticists, IHQSE Director Dr. Jeff Glasheen helped create and implement an EHR-driven tool that accurately predicts inpatient mortality. The tool, using real-time data from Epic, provides a highly predictive mortality score that is updated every 15 minutes across a 12-hospital health system. Tested on over 80,000 patients, the tool was developed to aid decision making in scarce resource situations, such as COVID-19 ventilator shortages.
IHQSE Faculty member, Emily Gottenborg, MD, and her colleague, Amy Yu, MD, are first authors on an article about the pandemic's impact on personal and professional activities of healthcare providers. They suggest solutions to help mitigate the impact, such as continuing alternate and flexible work schedules, developing flexible promotion timelines, investing in family support mechanisms, creating social support networks, and addressing gender pay disparities.
Ninety percent of patients labeled as penicillin allergic are tolerant to the medication, yet those labeled as allergic have longer hospital stays, increased exposure to suboptimal antibiotics, and an increased risk of methicillin-resistant infections. Through several quality improvement interventions, including development of a multidisciplinary clinical care pathway, workflow optimization, and education sessions, a team from Children’s Hospital Colorado successfully increased the rate of penicillin allergy delabeling among low-risk hospitalized pediatric patients. Led by Certificate Training Program graduates Drs. Maureen Egan Bauer and Kirstin Carel, Christine MacBrayne, PharmD, and Amy Stein, CPNP, this work allowed for increased use of optimal antibiotics.
Among the myriad impacts that the COVID-19 pandemic had on medicine and patient care, restrictions on face-to-face interactions among practitioners are often overlooked. In a commentary written for The Joint Commission Journal on Quality and Patient Safety, IHQSE alum, Dr. Sarah Parker, explores how collaborative processes like “handshake” antimicrobial stewardship have adapted to the challenge posed by social distancing and increased virtual communication.
Dr. Emily Gottenborg, IHQSE faculty member and Director of the Introductory Training Program, was the lead author on a seminal paper understanding the experiences of women in leadership roles in hospital medicine. Her team highlighted four limiting challenges including lack of leadership training, bullying, a need to sacrifice to achieve balance and the need for personal and professional validation. Key interventions to address these issues were also shared.