Implementation of a Children's Hospital Acute Care Behavior Response Team.

Background: Pediatric patients with behavioral needs are frequently admitted to the hospital for medical care; when behavioral crises occur, patients and staff are at risk for injury. Our aim was to implement a behavior response team (BRT) to increase the days between employee injury due to aggressive patient interactions on the inpatient medical units from 99 to 150 over 1 year.

Methods: A multidisciplinary team used quality improvement methods to design and implement the BRT system that includes 2 options: huddle to proactively plan for patients exhibiting early signs of escalation and STAT for immediate help for patients with imminent risk of harm to self or others.

Quality Improvement to Reduce High-Flow Nasal Cannula Overuse in Children With Bronchiolitis.

Background: High-flow nasal cannula oxygen therapy (HFNC) is increasingly used to treat bronchiolitis. However, HFNC has not reduced time on supplemental oxygen, length of stay (LOS), or ICU admission. Our objective was to reduce HFNC use in children admitted for bronchiolitis from 41% to 20% over 2 years.

How to Perform Quality Improvement Projects.

Safety and efficiency remain salient concerns for the US health-care system, especially in the face of growing health-care costs and morbidity from low-quality care. Current estimates suggest that more than 20% of health-care costs in the United States represent waste and low-value care, presenting numerous improvement opportunities. Although current guidelines and standards aim to address these problems, system processes and clinician behavior must also change to fill care gaps in the health-care system.

Decreasing Time to Full Enteral Feeds in Hospitalized Children With Medical Complexity Experiencing Feeding Intolerance.

Background And Objectives: Children with medical complexity (CMC) with gastrostomy and jejunostomy tubes are commonly hospitalized with feeding intolerance, or the inability to achieve target enteral intake combined with symptoms consistent with gastrointestinal dysfunction. Challenges resuming feeds may prolong length of stay (LOS). Our objective was to decrease median time to reach goal feeds from 3.

Improving Discharge Efficiency and Charge Containment on a Pediatric Acute Care Cardiology Unit.

Background: Hospital discharge delays can negatively affect patient flow and hospital charges. Our primary aim was to increase the percentage of acute care cardiology patients discharged within 2 hours of meeting standardized medically ready (MedR) discharge criteria. Secondary aims were to reduce length of stay (LOS) and lower hospital charges.

Short-term Focused Feedback: A Model to Enhance Patient Engagement in Research and Intervention Delivery.

Background: Our grant from the Patient-Centered Outcomes Research Institute (PCORI) focused on the use of nurse home visits postdischarge for primarily pediatric hospital medicine patients. While our team recognized the importance of engaging parents and other stakeholders in our study, our project was one of the first funded to address transitions of care issues in patients without chronic illness; little evidence existed about how to engage acute stakeholders longitudinally.

Objective: This manuscript describes how we used both a short-term focused feedback model and longitudinal engagement methods to solicit input from parents, home care nurses, and other stakeholders throughout our 3-year study.

Decreasing Hospital Observation Time for Febrile Infants.

Background: Febrile infants aged 0 to 60 days are often hospitalized for a 36-to-48 hour observation period to rule out invasive bacterial infections (IBI). Evidence suggests that monitoring blood and cerebrospinal fluid (CSF) cultures for 24 hours may be appropriate for most infants. We aimed to decrease the average culture observation time (COT) from 38 to 30 hours among hospitalized infants 0 to 60 days old over 12 months.

Performance of Pediatric Readmission Measures.

Background: Readmission rates are frequently used as a hospital quality metric; yet multiple measures exist to evaluate pediatric readmission rates. We sought to assess how four different measures of pediatric readmission compare with assessment of both preventable and unplanned readmission.

Methods: Clinicians on hospital medicine, cardiology, neonatology, and neurology teams reviewed medical records for 30-day readmissions using an abstraction tool with high interrater reliability for preventability assessment.

Nutrition and Preventative Medicine Across the Lifespan: Implementation of a Physician Assistant Team-Based Learning Curriculum on Pediatric Preventative Medicine.

Purpose: Physician assistants (PAs) will increasingly fill an important primary care gap in pediatrics. This study implemented a pediatric preventative care curriculum using a team-based learning (TBL) strategy and then evaluated the effect on first-year PA students' knowledge and attitudes toward TBL as a teaching method.

Methods: The curriculum was developed and implemented during a one-semester course.

A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit.

Background: The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions.

Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.

Aim: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.

Design: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use.

Methods: We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial.

Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge.

Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge.

Going back to the ward-transitioning care back to the ward team.

Transition of care from the intensive care unit (ICU) to the ward is usually an indication of the patient's improving clinical status, but is also a time when patients are particularly vulnerable. The transition between care teams poses a higher risk of medical error, which can be mitigated by safe and complete patient handoff and medication reconciliation. ICU readmissions are associated with increased mortality as well as ICU and hospital length of stay (LOS); however tools to accurately predict ICU readmission risk are limited.

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge: The H2O II Randomized Clinical Trial.

Importance: Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.

Objective: To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success.

Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial.

Background: Hospital discharge is stressful for children and families. Poor transitional care is linked to unplanned health care reuse. We evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial.

Quality Improvement Feature Series Article 3: Writing and Reviewing Quality Improvement Manuscripts.

Achieving rapid and meaningful improvement in healthcare requires the dissemination of quality improvement project results via publication. Doing this well requires detailed descriptions of the complex interventions and of the context in which the improvement took place. This report builds on the first 2 articles in the series to cover important considerations in writing quality improvement manuscripts with a focus on how it differs from writing traditional clinical research reports.