Wednesday, November 9, 2011

Quality and Safety Mini-Grants: A Year in Review

The MassGeneral Hospital for Children Quality and Safety Program recently completed its first year of the Mini Grant Program, encouraging projects related to process improvement, safety and/or quality programs at MassGeneral Hospital for Children.

The grants are expected to:

Address a quality or safety issue in the division
•    Be small enough that significant progress can be made within the coming year
•    Involve a multidisciplinary team (including physicians, nurses, front desk staff, pharmacy, social services, Child Life Services, etc.)
•    Have specific, measurable goals and outcomes

In 2011, Quality and Safety awarded grants to the following six projects:

Autism Hospital Admission Plans: Improving the In-Hospital Experience for Patients with Autism and their Families 

Project leader: Sarabeth Broder-Fingert, MD

Dr. Broder-Fingert and her team aimed to improve patient and caregiver satisfaction with the hospitalization experience for patients with autism. She designed a survey to obtain patient satisfaction feedback and to aid in the development of autism-specific resources for patients. The team developed a documentation template, which includes the patients’ autism-specific needs in an Autism Care Plan (ACP) and is now available in the patients’ LMR record. Thus far 40 patients have completed an ACP.

A Family-Centered Approach to the Pediatric Intensive Care Unit (PICU) Admission Process

Project leader: Phoebe Yager, MD

Dr. Yager and her team worked to enhance the family-centered admission process to the PICU at MassGeneral Hospital for Children by minimizing the amount of time families are separated from their loved ones at the time of admission and providing families with a guide to the PICU. The guide includes information about visitation, an introduction to the care team members and their roles, information about how rounds work and when they occur, and other available support resources. Pre-intervention data was collected to determine the average time that lapsed prior to inviting parents to the bedside. Post-intervention data demonstrated a 25% increase in the number of times parents were not separated from their child during the admission process.

Implementation of the Admission Check List in the Neonatal Intensive Care Unit (NICU)Project leader: Sergei Roumianstev, MD, PhD

Admission of a patient to NICU is a collaborative, multidisciplinary effort. Delays from a single event during the admission generally trigger further delays in the admission process. Dr. Roumianstev and his team worked to reduce the time to surfactant administration to less than two hours with the help of an admission checklist. Surfactant is a substance that is lacking in premature infants’ lungs and when given as a medication, it improves lung function, decreases complications and improves outcomes in these infants. The five-step checklist is now used as a standardized tool to guide admissions to the NICU. Since the implementation of the admission checklist and other process improvement initiatives, both the average time to surfactant administration and its variability have significantly decreased, with the average time to administration reduced nearly 30 percent from 105 minutes to 75 minutes.

Communication, Connection and Quality: An Education Pilot to Enhance Resident Communication Skills 

Project leader: Sandra Clancy, PhD

MGHfC lacked a communications skills component to the training program for pediatric residents. This project developed and carried out five, four-hour training sessions featuring simulations of real-life health care communications challenges aimed at improving residents’ comfort and skill in this area. The 20 residents who went through the pilot program gave it an overall score of 4.6/5.  In a resident self-report that surveyed all pediatric residents regarding their perceptions of how their skills relating to communications had changed since the beginning of the residency year, all 35 respondents reported improvement in their skills related to communications, whether they had taken the session or not. Many reported that they had improved because of experience, but the Communications Pilot Program was the only formal part of resident training that residents identified as improving their comfort, preparation and skill in communication and was recommended by several as an experience they would like integrated into pediatric residency. It has now been integrated as a permanent component of the residency training program at MassGeneral Hospital for Children. Read the story.

Improvement of Survey Metrics: “Wait Times,” “Staff Courteous,” “Staff Helpful” in the Pediatric Gastroenterology and Nutrition Clinic 

Project leader: Maria Mancinelli

The Gastroenterology and Nutrition practice’s scores on the “wait times,” “staff courteous” and “staff helpful” metrics have been below the Massachusetts General Hospital Specialty Care Top Box percentage in the Clinician and Group Consumer Assessment of Healthcare Providers Survey (CG-CAHPS) survey. Ms. Mancinelli and her team planned to improve scores for these metrics by 5% during the grant period in the Yawkey 6 clinic. Through process changes (having physicians enter imaging requests in Radiology Order Entry (ROE) and re-routing phone calls from the receptionist to staff in the back office) and systemic changes (implementation of the Medical Appointment Board Link, which displays wait times), scores for the three metrics improved significantly more than the 5% goal. For “staff courteous,” the Top Box score increased from 69% to 85%; “helpful staff” increased from 69% to 85%, and “informed of wait times” (No) decreased from 80% to 70%. (Data compares calendar year 2010 to January through September 2011).

The GRAD Program- Gearing Responsibility in an Adult Direction- A Transitions Program for Type 1 Diabetes CareProject leader: Barb Luby, LICSW

The GRAD Program aimed to facilitate a smooth transfer of diabetes care from a pediatric to adult endocrinologist while also supporting children to participate in their disease management as they develop from childhood through adolescence. A multidisciplinary team worked to produce educational and age-appropriate materials as well as a new care structure to include “transitions” visits. Although only one patient has been enrolled in the program thus far, the team has been able to raise awareness of the issue in the diabetes clinic and has built relationships with adult providers to whom the patients will transition.

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