Developing the Capacity for Rapid-Cycle Improvement at a Large Freestanding Children's Hospital.

Background: To develop the capacity for rapid-cycle improvement at the unit level, a large freestanding children's hospital designated 2 inpatient units with normal patient loads and workforce as pilot "Innovation Units" where frontline staff was trained to lead rigorous improvement portfolios.

Methods: Frontline staff received improvement training, and interdisciplinary teams brainstormed ideas for tests of change. Ideas were prioritized using an impact-effort evaluation and an assessment of how they aligned with high-level goals.

Evolution of a Rapid Hydration Protocol.

The Oncology Division of the Children's Hospital of Philadelphia (CHOP) embarked on a comprehensive project to reduce chemotherapy errors. Careful review of all systems revealed many areas for improvement. Using a unique systems improvement approach, the interdisciplinary team carried out many concurrent change projects.

Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains.

Purpose: The problem of medication safety came to public attention largely through a chemotherapy error, and the high toxicity and low therapeutic index of anticancer medications make safety in their prescription and administration critical. We have undertaken a thorough revision of our systems for inpatient chemotherapy.

Methods: We participated in a multi-institutional collaborative effort of the Institute for Healthcare Improvement, and used their rapid cycle change method.