Methods to Increase Reliability in Quality Improvement Projects.

Although many quality improvement initiatives in health care see early and laudable success, 1 of the greatest challenges is sustaining the gains and avoiding the natural tendency of systems to revert to their original state, function, and outcomes. Reliability science describes a mathematical and systematic framework for understanding the level of reliability of interventions, and therefore the anticipated success and failure rate of both the steps of a process and the cumulative process overall. Successful utilization of this framework, along with the mindful organizing principles of high-reliability organizations, will facilitate ongoing and long-lasting improvement in outcomes.

Improving Employee Safety Through a Comprehensive Patient Behavioral Program.

Background: Health care workers in the United States are facing increasing rates of exposure to aggressive behavior, resulting in an increase in employee injuries related specifically to patient behavioral events. By leveraging interprofessional collaboration and system-level innovation, we aimed to reduce the rate of employee injuries related to patient behavioral events at a children's hospital by 50% over a 3-year period.

Methods: An interdisciplinary quality improvement team comprising physicians, behavior analysts, nursing, and other key stakeholders developed a comprehensive behavior program in our children's hospital.

GJ Express: an improvement initiative to decrease sedation and anesthesia for gastrojejunostomy tube exchanges.

Background: Overuse of sedation and anesthesia causes delays in gastrojejunostomy tube (GJ) exchanges, increased risk of complications, unnecessary use of resources, preventable hospital admissions, and an adverse impact on patient and family experience. Our hospital was over-utilizing sedation and anesthesia, and we aimed to decrease this use from 78% to 20% within two years.

Methods: An interdisciplinary quality improvement team comprehensively evaluated current processes for GJ tube exchanges through a retrospective chart review for baseline data with prospective time series analysis after improvement implementation.

Multiuser immersive virtual reality simulation for interprofessional sepsis recognition and management.

Introduction: Sepsis is a leading cause of pediatric mortality. While there has been significant effort toward improving adherence to evidence-based care, gaps remain. Immersive multiuser virtual reality (MUVR) simulation may be an approach to enhance provider clinical competency and situation awareness for sepsis.