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1.
PLoS One ; 15(2): e0228377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012194

RESUMO

AIM: To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA). METHODS: A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant. RESULTS: Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]). CONCLUSIONS: These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hospitais Pediátricos/normas , Pediatras/psicologia , Pediatria/educação , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Síndromes da Apneia do Sono/terapia , Criança , Estudos Transversais , Humanos , Itália , Análise de Classes Latentes , Pediatras/normas , Pediatras/estatística & dados numéricos , Pediatria/normas , Satisfação Pessoal , Projetos Piloto , Inquéritos e Questionários
2.
J Bone Joint Surg Am ; 101(18): 1679-1688, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567805

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is a heavily utilized resource to evaluate children suspected to have a musculoskeletal infection. Complex interdisciplinary workflows are involved with decision-making with regard to indications, anesthesia, contrast use, and procedural timing relative to the scan. This study assesses the impact of a quality improvement endeavor on MRI workflows at a tertiary pediatric medical center. METHODS: A registry of consecutively enrolled children for a multidisciplinary musculoskeletal infection program identified those evaluated with MRI from 2012 to 2018. Annual MRI process improvement feedback was provided to the key stakeholders. Demographic characteristics, laboratory parameters, MRI indications, anesthesia use, MRI findings, final diagnoses, scan duration, imaging protocol, surgical intervention following MRI, and length of stay were retrospectively compared between the 3 cohorts (initial, middle, and final) representing 2-year increments to assess the impact of the initiative. RESULTS: There were 526 original MRI scans performed to evaluate 1,845 children with suspected musculoskeletal infection. Anesthesia was used in 401 children (76.2%). When comparing the initial, middle, and final study period cohorts, significant improvement was demonstrated for the number of sequences per scan (7.5 sequences for the initial cohort, 5.8 sequences for the middle cohort, and 4.6 sequences for the final cohort; p < 0.00001), scan duration (73.6 minutes for the initial cohort, 52.1 minutes for the middle cohort, and 34.9 minutes for the final cohort; p < 0.00001), anesthesia duration (94.1 minutes for the initial cohort, 68.9 minutes for the middle cohort, and 53.2 minutes for the final cohort; p < 0.00001), and the rate of contrast use (87.6% for the initial cohort, 67.7% for the middle cohort, and 26.3% for the final cohort; p < 0.00001). There was also a trend toward a higher rate of procedures under continued anesthesia immediately following the MRI (70.2% in the initial cohort, 77.8% in the middle cohort, and 84.6% in the final cohort). During the final 6-month period, the mean scan duration was 24.4 minutes, anesthesia duration was 40.9 minutes, and the rate of contrast administration was 8.5%. CONCLUSIONS: Progressive quality improvement through collaborative interdisciplinary communication and workflow redesign led to improved utilization of MRI and minimized contrast use for suspected musculoskeletal infection. There was a high rate of procedural intervention under continued anesthesia for children with confirmed musculoskeletal infection. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Hospitais Pediátricos/normas , Imagem por Ressonância Magnética/normas , Doenças Musculoesqueléticas/diagnóstico por imagem , Melhoria de Qualidade/organização & administração , Centros de Atenção Terciária/normas , Fluxo de Trabalho , Adolescente , Criança , Pré-Escolar , Protocolos Clínicos , Meios de Contraste , Feminino , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Sistema de Registros , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Texas , Fatores de Tempo , Adulto Jovem
3.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31416826

RESUMO

BACKGROUND AND OBJECTIVES: Vital signs are important data elements in the pediatric emergency department (PED). The presence of unexplained tachycardia at discharge has been associated with patient return to the PED and subsequent admission. Our aim for this study was to increase the percentage of patients discharged with a complete set of vital signs, when indicated, from 22% to 95% by June 30, 2018. METHODS: A multidisciplinary team developed key drivers, and data were collected by using a retrospective chart review. Outcome measures were the percentage of patients with discharge vital signs and 72-hour returns to the PED. Balancing measures included PED length of stay (LOS) and hospital admissions. Data were compiled from a chart review 7 times monthly; all charts were of patients presenting to the PED during the days being reviewed. An annotated p-chart was used to analyze the data. RESULTS: Data were collected for 18 months, including baseline data from July to September 2017, during which time 22% of patients had discharge vital signs. Targeted quality improvement methodology initially improved discharge vital signs to 41%, and then to 85%, which has been sustained for 7 months. There was no change in 72-hour return PED visits or LOS. Although absolute hospitalizations remained stable, the percentage of patients admitted increased. CONCLUSIONS: Targeted quality improvement methodology is associated with sustained improvement of indicated discharge vital signs for patients discharged from the PED. This improvement was not associated with reduced return PED visits, prolonged LOS, or increased hospitalization.


Assuntos
Documentação , Serviço Hospitalar de Emergência/normas , Hospitais Pediátricos/normas , Alta do Paciente , Sinais Vitais , Criança , Registros Eletrônicos de Saúde/normas , Humanos , Tempo de Internação , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Melhoria de Qualidade , Estudos Retrospectivos
4.
Anesth Analg ; 129(3): 794-803, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425222

RESUMO

BACKGROUND: Noise in the operating room may cause distractions during critical periods and impair reliable communication between staff. Even momentary inefficiency while administering anesthesia can lead to errors and serious consequences for the patient. Distractions to an anesthesia provider during critical periods such as induction and emergence are a patient safety issue. Because of concerns regarding unacceptable noise levels and distractions during induction of general anesthesia, our institution developed a quality improvement initiative, the "Distraction-Free Induction Zone." The specific aim of this project was to decrease the percentage of cases with a distraction, described as music, unnecessary conversations, or loud noises, occurring during induction of general anesthesia in pediatric otolaryngology operating rooms from 61% to 15%. METHODS: To complete this quality improvement initiative, a multidisciplinary team used improvement science methods, including The Model for Improvement with interventions tested via Plan-Do-Study-Act cycles. We used tools such as the Key Driver Diagram, Pareto Charts, Process Flow Chart, and Plan-Do-Study-Act worksheets. Data were manually collected and entered weekly in an Excel spreadsheet. Statistical process control methods, including a run chart and a P-control chart, were used for data analysis. Our measure was a composite measure in which observation of 1 of the 3 distractions during induction of general anesthesia categorized the case as a case with a distraction. RESULTS: We tested and implemented several interventions via Plan-Do-Study-Act cycles in which 3 main interventions collectively were associated with an observed decrease in distractions during induction of general anesthesia. These included educating the perioperative staff present in the operating room to help them understand that distractions to anesthesia providers represent a patient safety issue, the operating room circulating nurse taking responsibility to pause any music on arrival to the operating room, and the anesthesiologist reminding the staff in the operating room of induction time and/or asking for quiet during induction if a distraction occurs. The percentage of cases with a distraction during induction of general anesthesia in our pediatric otolaryngology operating rooms decreased from 61% to 15% by April 15, 2017 and to 10% by June 5, 2017. CONCLUSIONS: Using improvement science methods, we observed a decrease in distractions during induction of general anesthesia, improved a process, and encouraged change in culture at a large academic children's hospital to enhance the quality and safety of the anesthetic care we provide our patients.


Assuntos
Centros Médicos Acadêmicos/normas , Anestesia Geral/normas , Pessoal de Saúde/normas , Hospitais Pediátricos/normas , Cuidados Pré-Operatórios/normas , Melhoria de Qualidade/normas , Centros Médicos Acadêmicos/métodos , Anestesia Geral/métodos , Anestésicos/administração & dosagem , Humanos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários
5.
Health Serv Res ; 54(5): 1007-1015, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31388994

RESUMO

OBJECTIVE: To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria. DATA SOURCES/STUDY SETTING: We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016. STUDY DESIGN: We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans. DATA COLLECTION/EXTRACTION METHODS: We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls. PRINCIPAL FINDINGS: Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO. CONCLUSIONS: Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.


Assuntos
Organizações de Assistência Responsáveis/normas , Crianças com Deficiência/reabilitação , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Pediátricos/normas , Programas de Assistência Gerenciada/normas , Medicaid/normas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Organizações de Assistência Responsáveis/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Crianças com Deficiência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Ohio , Estados Unidos
6.
Emerg Med J ; 36(9): 529-534, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326954

RESUMO

BACKGROUND: Trauma team activation criteria have a variable performance in the paediatric population. We aimed to identify predictors for high-level resource utilisation during trauma resuscitation in the ED. METHODS: A retrospective study was conducted in the ED of a tertiary paediatric hospital. Patient data were collected from trauma surveillance registry and analysis was performed to identify significant predictors. We then assessed the sensitivity and specificity of proposed models with respect to observed patient outcomes. RESULTS: Among 11 282 cases, the mean age was 6.1±4.9 (SD) years old. Fall was the most common mechanism of injury in 7364 (65.3%) patients. Eighty-eight (0.8%) patients required at least one high-level resource. Significant predictors for high-resource utilisation were overall GCS of <14 (relative risk (RR) 38.841, 95% CI 21.328 to 70.739, p<0.001), high-risk mechanisms of fall from height and motor vehicle collision (RR 7.863, 95% CI 4.687 to 13.192, p<0.001), as well as age-specific tachycardia (RR 1.796, 95% CI 1.145 to 2.817, p=0.0108). A model consisting of GCS and high-risk mechanism would under-triage 21 (0.2%) patients and over-triage 681 (6.0%) patients. When age-specific tachycardia was added, 8 (0.1%) less patients would be under-triaged but an additional 3251 (28.9%) patients would be over-triaged. CONCLUSION: As utilisation of high-level resources in paediatric trauma was rare, it was difficult to find an appropriate balance between under-triage and over-triage. Between the two, minimising the proportion of under-triage is more important as patient safety is paramount in paediatric trauma care.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Ressuscitação/estatística & dados numéricos , Ferimentos e Lesões/terapia , Criança , Pré-Escolar , Utilização de Instalações e Serviços/organização & administração , Utilização de Instalações e Serviços/normas , Feminino , Escala de Coma de Glasgow/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/normas , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Sistema de Registros/estatística & dados numéricos , Ressuscitação/normas , Estudos Retrospectivos , Singapura , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Triagem/organização & administração , Triagem/normas , Triagem/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico
7.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31345997

RESUMO

OBJECTIVES: Neonatal herpes simplex virus (HSV) infections are associated with high mortality and long-term morbidity. However, incidence is low and acyclovir, the treatment of choice, carries risk of toxicity. We aimed to increase the percentage of patients 0 to 60 days of age who are tested and treated for HSV in accordance with local guideline recommendations from 40% to 80%. METHODS: This quality improvement project took place at 1 freestanding children's hospital. Multiple plan-do-study-act cycles were focused on interventions aimed at key drivers including provider buy-in, guideline availability, and accurate identification of high-risk patients. A run chart was used to track the effect of interventions on the percentage managed per guideline recommendations over time by using established rules for determining special cause. Pre- and postimplementation acyclovir use was compared by using a χ2 test. In HSV-positive cases, delayed acyclovir initiation, defined as >1 day from presentation, was tracked as a balancing measure. RESULTS: The median percentage of patients managed according to guideline recommendations increased from 40% to 80% within 8 months. Acyclovir use decreased from 26% to 7.9% (P < .001) in non-high-risk patients but did not change significantly in high-risk patients (73%-83%; P = .15). There were no cases of delayed acyclovir initiation in HSV-positive cases. CONCLUSIONS: Point-of-care availability of an evidence-based guideline and interventions targeted at provider engagement improved adherence to a new guideline for neonatal HSV management and decreased acyclovir use in non-high-risk infants. Further study is necessary to confirm the safety of these recommendations in other settings.


Assuntos
Herpes Simples/diagnóstico , Herpes Simples/terapia , Hospitais Pediátricos/normas , Guias de Prática Clínica como Assunto/normas , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Melhoria de Qualidade/normas , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
8.
Pediatr Clin North Am ; 66(4): 725-737, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31230619

RESUMO

This article provides an overview of the selection, development, and use of process and outcome measures for pediatric hospital medicine quality improvement initiatives. It reviews commonly used categories of process and outcome measures and provides a list of common sources and repositories of previously validated measures. It also provides a blueprint for the development of novel measures. The relative merits of various data collection methods are discussed (eg, medical record abstraction, administrative, surveys), along with guiding principles for disseminating the results of quality improvement evaluations on a local and national level.


Assuntos
Medicina Hospitalar/normas , Médicos Hospitalares/normas , Hospitais Pediátricos/normas , Pediatria/normas , Melhoria de Qualidade , Humanos
9.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31085738

RESUMO

As part of establishing a gender surgery center at a pediatric academic hospital, we undertook a process of identifying key ethical, legal, and contextual issues through collaboration among clinical providers, review by hospital leadership, discussions with key staff and hospital support services, consultation with the hospital's ethics committee, outreach to other institutions providing transgender health care, and meetings with hospital legal counsel. This process allowed the center to identify key issues, formulate approaches to resolving those issues, and develop policies and procedures addressing stakeholder concerns. Key issues identified during the process included the appropriateness of providing gender-affirming surgeries to adolescents and adults, given the hospital's mission and emphasis on pediatric services; the need for education on the clinical basis for offered procedures; methods for obtaining adequate informed consent and assent; the lower and upper acceptable age limits for various procedures; the role of psychological assessments in determining surgical eligibility; the need for coordinated, multidisciplinary patient care; and the importance of addressing historical access inequities affecting transgender patients. The process also facilitated the development of policies addressing the identified issues, articulation of a guiding mission statement, institution of ongoing educational opportunities for hospital staff, beginning outreach to the community, and guidance as to future avenues of research and policy development. Given the sensitive nature of the center's services and the significant clinical, ethical, and legal issues involved, we recommend such a process when a establishing a program for gender surgery in a pediatric institution.


Assuntos
Disforia de Gênero/cirurgia , Hospitais Pediátricos/ética , Pediatria/ética , Especialidades Cirúrgicas/ética , Criança , Disforia de Gênero/diagnóstico , Disforia de Gênero/psicologia , Hospitais Pediátricos/normas , Humanos , Pediatria/normas , Especialidades Cirúrgicas/normas
10.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31072828

RESUMO

BACKGROUND AND OBJECTIVES: Lead exposure remains common and is associated with adverse intellectual and behavioral outcomes. Despite quality improvement used to increase screening rates, clinical response to elevated lead levels remains variable. Our aim was to increase provider adherence to published guidelines for addressing elevated lead levels. METHODS: We created a protocol for addressing elevated lead levels on the basis of published guidelines. The protocol included ordering multivitamins with iron and follow-up lead testing, educating families about identifying and reducing sources of lead exposure, and referring to a specialty environmental health clinic when indicated. We used quality improvement methods to increase provider adherence to the protocol in a large, academic primary care center among patients 9 to 27 months old. The outcome measure was the percentage of elevated lead levels for which providers adhered to all elements of the protocol. This measure was plotted on a control chart. Statistical process control was used to determine a significant change to system performance. RESULTS: Adherence to the protocol rose from 5% to 90%. Key interventions included decision support in the e-health records and weekly review of reports of lead levels. These interventions were supported by staffing adjustments and individualized feedback to create accountability. CONCLUSIONS: Simple process changes dramatically improved adherence to complex guidelines for addressing lead exposure in primary care. These changes could be used to similarly standardize clinical responses to other screens.


Assuntos
Hospitais Pediátricos/normas , Intoxicação por Chumbo/diagnóstico , Programas de Rastreamento/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Pré-Escolar , Feminino , Fidelidade a Diretrizes/normas , Humanos , Lactente , Chumbo/sangue , Intoxicação por Chumbo/sangue , Intoxicação por Chumbo/epidemiologia , Masculino , Programas de Rastreamento/métodos , Guias de Prática Clínica como Assunto/normas , Atenção Primária à Saúde/métodos
12.
Crit Care Nurse ; 39(2): e1-e7, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30936138

RESUMO

BACKGROUND: Low cardiac output syndrome is a transient constellation of signs and symptoms that indicate the heart's inability to supply sufficient oxygen to tissues and end-organs to meet metabolic demand. Because the term lacks a standard clinical definition, the bedside diagnosis of this syndrome can be difficult. OBJECTIVE: To evaluate concordance among pediatric cardiac intensive care unit nurses in their identification of low cardiac output syndrome in pediatric patients after cardiac surgery. METHODS: An anonymous survey was distributed to 69 pediatric cardiac intensive care unit nurses. The survey described 10 randomly selected patients aged 6 months or younger who had undergone corrective or palliative cardiac surgery at a freestanding children's hospital in a tertiary academic center. For each patient, data were presented corresponding to 5 time points (0, 6, 12, 18, and 24 hours postoperatively). The respondent was asked to indicate whether the patient had low cardiac output syndrome (yes or no) at each time point on the basis of the data presented. RESULTS: The response rate was 46% (32 of 69 nurses). The overall Fleiss k value was 0.30, indicating fair agreement among raters. When the results were analyzed by years of experience, agreement remained only slight to fair. CONCLUSIONS: Regardless of years of experience, nurses have difficulty agreeing on the presence of low cardiac output syndrome. Further research is needed to determine whether the development of objective guidelines could improve recognition and facilitate communication between the pediatric cardiac intensive care unit nurse and the medical team.


Assuntos
Baixo Débito Cardíaco/diagnóstico , Baixo Débito Cardíaco/enfermagem , Enfermagem Cardiovascular/normas , Enfermagem de Cuidados Críticos/normas , Hospitais Pediátricos/normas , Unidades de Terapia Intensiva Pediátrica/normas , Guias de Prática Clínica como Assunto , Enfermagem Cardiovascular/estatística & dados numéricos , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Educação Continuada em Enfermagem , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Inquéritos e Questionários
13.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30890559

RESUMO

BACKGROUND AND OBJECTIVES: Paging is a primary mode of communication in hospitals, but message quality varies. With this project, we aimed to standardize paging, thus improving end user (EU) satisfaction, patient safety, and efficiency. Objectives were to increase the percent of pages containing 6 critical elements (CEs) (ie, the sender's first and last name, a 7-digit callback number, patient name, room number, and urgency indicator [information only, call, or come] to 90%); improve EU satisfaction to 80% rating paging communication as good or excellent; and decrease the frequency of safety events related to paging. METHODS: This multidisciplinary, system-wide quality improvement study was conducted at our stand-alone academic children's hospital. CEs were determined by EU consensus. Outcome measures were inclusion of all 6 CEs, provider satisfaction, and frequency of safety events. Process measures were inclusion of individual CEs and appropriateness and timeliness of response to pages. Balancing measures included number of work-arounds (WAs). Interventions included education, engineering a platform with required fields, and optimization enhancements. Statistical process control charts (p-charts; XmR) were used to track the impact of interventions. RESULTS: Special-cause improvement was noted in use of all 6 CEs (4.4%-79.7%) and individual CEs. EU satisfaction improved from 50% to 85% rating paging communication as good or excellent. Safety events related to paging remain infrequent. Specific WA use decreased by 60%. CONCLUSIONS: System-wide use of required fields produced significant improvement in inclusion of all 6 CEs and EU satisfaction. WAs were curbed by improving the ease of CE incorporation. Required fields should be considered at institutions seeking improved paging communication.


Assuntos
Sistemas de Comunicação no Hospital/normas , Hospitais Pediátricos/normas , Melhoria de Qualidade , Centros Médicos Acadêmicos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Comunicação Interdisciplinar , Masculino , Padrões de Referência , Wisconsin
14.
BMC Anesthesiol ; 19(1): 42, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917782

RESUMO

BACKGROUND: Nitrous oxide has a proven clinical efficacy in conscious sedation. At certain environmental concentrations it may pose a health risk to chronically exposed healthcare workers. The present pilot study aims at evaluating the exposure to nitrous oxide of dental ambulatory personnel of a pediatric hospital. METHODS: A descriptive study design was conducted in two phases: a bibliographic analysis on the environmental safety policies and a gas concentration analysis in the dental ambulatories of a pediatric hospital, detected every 6 months from December 2013 to February 2017 according to law provisions. The surveys were carried out using for gas analysis a photoacoustic spectrometer Innova-B&K "Multi-gas monitor model 1312" and Innova-B&K "Multi-sampler model 1309". The biological analysis and monitoring have been carried out on staff urine. RESULTS: The analyses were performed during 11 dental outpatient sessions on pediatric patients. All the patients were submitted to the same dental procedures, conservative care and dental extractions. The pediatric patients were 47 (23 males, 24 females; age range 3-17 years; mean age 6,63, SD ± 2,69) for a mean of 4,27 (SD ± 1,49) per session., The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm (SD ±16,16). A correlation was found between urinary nitrous oxide concentration of dentists (Pearson's correlation 0.786; p = 0.007) and dental assistants urines (Pearson's correlation 0.918; p < 0.001) and environmental concentrations of nitrous oxide. Weak negative correlations were found between age and sex of patients and environmental concentrations of nitrous oxide. The mean values of the biological monitoring data referring to all the outpatient sessions are lower than the reference values foreseen in accordance to the regulations in force on nitrous oxide concentration. CONCLUSIONS: The mean environmental concentration values recorded in our study are below the limit of 50 ppm considered as a reference point, a value lower than those reported in other similar surveys. The results of the present study provide a contribution to the need to implement technical standards, criteria and system requirements for the dental ambulatories, to date not yet completely defined, and cannot be assimilated to the ones established for the surgical rooms.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Sedação Consciente/normas , Assistentes de Odontologia/normas , Odontólogos/normas , Hospitais Pediátricos/normas , Óxido Nitroso/urina , Exposição Ocupacional/análise , Adolescente , Procedimentos Cirúrgicos Ambulatórios/métodos , Criança , Pré-Escolar , Sedação Consciente/métodos , Monitoramento Ambiental/métodos , Monitoramento Ambiental/normas , Feminino , Humanos , Itália/epidemiologia , Masculino , Óxido Nitroso/administração & dosagem , Projetos Piloto , Estudos Retrospectivos
15.
Nurs Clin North Am ; 54(1): 21-32, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30712543

RESUMO

The purpose of this quality improvement study was to describe the process for workplace aggression (WPA) reporting and the potential failures for this process in a pediatric emergency department. Interviews were conducted with 10 interdisciplinary employees. Findings yielded 7 tasks following WPA: contact security, contact police, contact clinical manager, notify emergency department director, call safety hotline, complete electronic safety form, and complete paper safety form. Focusing actions to prevent failure modes and causes for (1) notification of the emergency department director and (2) completion of an electronic safety form can garner the greatest improvement in overall risk for WPA reporting.


Assuntos
Serviço Hospitalar de Emergência/normas , Guias como Assunto , Hospitais Pediátricos/normas , Notificação de Abuso , Melhoria de Qualidade/normas , Violência no Trabalho/estatística & dados numéricos , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos
16.
Pediatrics ; 143(3)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30760508

RESUMO

OBJECTIVES: Excessive alerts are a common concern associated with clinical decision support systems that monitor drug-drug interactions (DDIs). To reduce the number of low-value interruptive DDI alerts at our hospital, we implemented an iterative, multidimensional quality improvement effort, which included an interdisciplinary advisory group, alert metrics, and measurement of perceived clinical value. METHODS: Alert data analysis indicated that DDIs were the most common interruptive medication alert. An interdisciplinary alert advisory group was formed to provide expert advice and oversight for alert refinement and ongoing review of alert data. Alert data were categorized into drug classes and analyzed to identify DDI alerts for refinement. Refinement strategies included alert suppression and modification of alerts to be contextually aware. RESULTS: On the basis of historical analysis of classified DDI alerts, 26 alert refinements were implemented, representing 47% of all alerts. Alert refinement efforts resulted in the following substantial decreases in the number of interruptive DDI alerts: 40% for all clinicians (22.9-14 per 100 orders) and as high as 82% for attending physicians (6.5-1.2 per 100 orders). Two patient safety events related to alert refinements were reported during the project period. CONCLUSIONS: Our quality improvement effort refined 47% of all DDI alerts that were firing during historical analysis, significantly reduced the number of DDI alerts in a 54-week period, and established a model for sustained alert refinements.


Assuntos
Interações Medicamentosas/fisiologia , Hospitais Pediátricos/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Sistemas de Medicação no Hospital/normas , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Apoio a Decisões Clínicas/tendências , Hospitais Pediátricos/tendências , Humanos , Sistemas de Registro de Ordens Médicas/tendências , Sistemas de Medicação no Hospital/tendências , Sistemas de Alerta/normas , Sistemas de Alerta/tendências
17.
Curr Pharm Biotechnol ; 20(8): 635-642, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30747063

RESUMO

BACKGROUND: Healthcare quality improvements are one of the most important goals to reach a better and safer healthcare system. Reviewing in-hospital mortality data is useful to identify areas for improvement, and to monitor the impact of actions taken to avoid preventable cases, such as those related to healthcare associated infections (HAI). METHODS: In this paper, we present the experience of the Mortality Committee of Bambino Gesù Children Hospital (OPBG). OPBG has instituted a process of systematic revision of all in-hospital deaths conducted by a multidisciplinary team. The goal is to identify system-wide issues that could be improved to reduce in-hospital preventable deaths. In this way, the mortality review goes alongside all the other risk management activities for the continuous quality improvement and patient safety. RESULTS: In years 2008-2017, we performed a systematic analysis of 1148 inpatient deaths. In this time period, the overall mortality rate was 0.4%. Forty-seven deaths were caused due to infections, 10 of which involved patients with HAI transferred to OPBG from other facilities or patients with community- acquired infections. Six deaths related to HAI were followed by claims compensations. All these cases were not followed by compensation because the onset of HAI was considered an inevitable consequence of the underlying disease. CONCLUSION: Introduction of the mortality review committee has proved to be a valid instrument to improve the quality of the care provided in a hospital, allowing early identification of care gaps that could lead to an increase in mortality rates. Article Highlights Box: Reduction of preventable deaths is one of the most important goals to be achieved for any health-care system and to improve the quality of care. • Several studies have shown that analysis of morbidity and mortality rate helps to detect any factors that can lead to an increase in in-hospital mortality rates. • The review of in-hospital deaths allows to learn how to improve the quality and safety of care through identification of critical issues that lead to an increase in mortality ratio. • In some medical areas, such as intensive care units or surgery, the implementation of the conference on mortality and morbidity is more useful for assessing procedures at high risk of errors. • The implementation of existing databases with data deriving from the systematic review of medical records and in-hospital deaths appears to be desirable. • Mortality Review Committees can represent a very useful tool for all the health facilities for the reduction of preventable deaths, such as those related to HAI.


Assuntos
Bases de Dados Factuais , Assistência à Saúde/tendências , Mortalidade Hospitalar/tendências , Hospitais Pediátricos/tendências , Qualidade da Assistência à Saúde/tendências , Criança , Assistência à Saúde/normas , Hospitais Pediátricos/normas , Humanos , Itália , Estudos Retrospectivos , Revisões Sistemáticas como Assunto
18.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30674609

RESUMO

: media-1vid110.1542/5972296743001PEDS-VA_2018-0496Video Abstract BACKGROUND: Developing a research agenda that is focused on the priorities of key stakeholders may expedite implementation and dissemination. Our objective was to identify the highest-priority patient-safety research topics among pediatric clinicians, health care leaders, and families. METHODS: The Children's Hospitals Solutions for Patient Safety Network is a network of >100 children's hospitals working together to eliminate harm due to health care. Parents and site leaders responded to an open-ended, anonymous e-mail survey used to elicit research topics. A key stakeholder panel winnowed related topics and prioritized topics using Likert scale ratings. Site leaders and parents responded to a second anonymous e-mail survey and rated the importance of each topic. Health system executive interviews were used to elicit their opinions regarding top priorities for patient-safety research. RESULTS: The elicitation survey had 107 respondents who produced 49 unique research topics. The key stakeholder panel developed a final list of 24 topics. The prioritization survey had 74 respondents. Top-priority research topics concerned high reliability, safety culture, open communication, and early detection of patient deterioration and sepsis. During 7 qualitative interviews, health system executives highlighted diagnostic error, medication safety, deterioration, and ambulatory patient safety as priority areas. CONCLUSIONS: With this study, we take a first step toward a stakeholder-driven research agenda on the basis of the assumption that stakeholders are best positioned to determine what research will be used to address the problems of most concern to them.


Assuntos
Pessoal de Saúde/normas , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/normas , Hospitais Pediátricos/normas , Segurança do Paciente/normas , Pesquisa/normas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
19.
Paediatr Anaesth ; 29(3): 258-264, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30609186

RESUMO

BACKGROUND: Medication errors pose a significant risk perioperatively. In the perioperative environment, common medication administration processes are not typically performed. Given the common administration of potentially harmful medications and the potential for medication errors, patient risk is substantial. Specifically, intravenous acetaminophen has been used more frequently in the perioperative period which yielded an increase in medication administration errors reported. AIMS: This project was initiated by Cincinnati Children's Hospital after an increase in perioperative acetaminophen dosing errors was reported. After mapping the administration process of perioperative acetaminophen, we sought to reduce medication errors by the use of a safety checklist. Acetaminophen was used as a surrogate for other perioperative medications in this quality improvement project. METHODS: Use of a failure mode effects analysis assisted the team in understanding the failures of the process of safe medication administration. Subsequently, key drivers of this process were designed to include accurate understanding and documentation of medication history, consistent communication between perioperative caregivers, and an efficient checklist process. A multidisciplinary team conducted a series of tests to modify key drivers. Data were collected by utilizing data from a paper checklist, prior to the electronic medical record change that was prompted by this study. A total of 633 checklists and electronic medical records were analyzed during a 6-month period; data were analyzed using control charts and statistical process control methods. RESULTS/ANALYSIS: The percentage of compliance with the safe administration checklist for acetaminophen in the preoperative period increased to 97%. Use of the paper checklist likely prompted the appropriate increase in compliance with safe administration. Additionally, provider-specific feedback produced a significant increase in compliance with the use of the checklist. CONCLUSION: Application of quality improvement methods, specifically a safety checklist, were utilized to improve the safe administration of acetaminophen during the perioperative period. Increasing reliability of accurate delivery and administration of medication to patients are crucial in optimizing patient safety. Use of a medication safety checklist may be beneficial in reducing potential administration errors, specifically for high-risk medications.


Assuntos
Acetaminofen/administração & dosagem , Anestesia/normas , Lista de Checagem/métodos , Hospitais Pediátricos/normas , Adesão à Medicação , Erros de Medicação/prevenção & controle , Anestesia/métodos , Lista de Checagem/normas , Criança , Registros Eletrônicos de Saúde , Humanos , Erros de Medicação/estatística & dados numéricos , Segurança do Paciente , Melhoria de Qualidade
20.
Dev Neurorehabil ; 22(7): 445-452, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30235044

RESUMO

Purpose: To investigate the value of shared opportunities for positive distraction in pediatric healthcare environments. Methods: Self-selected activities of 271 young people (5-19 years) with diverse neurodevelopmental conditions were observed in an ambulatory pediatric rehabilitation clinic. Shared opportunities included hands-free media (nature video or interactive media) and an aquarium. Anxiety was self-reported on the State Trait Anxiety Scale upon arrival and after 10 minutes in the waiting space. Results: Young people engaged more with shared opportunities for distraction (n = 170/271) than personal items brought from home (n = 119/271), p = 0.02. Personal electronic devices were used by 67 young people, but did not positively impact anxiety. Interactive media and the aquarium significantly reduced anxiety (p < 0.04) while the nature video appeared to increase anxiety (p = 0.036). Age influenced activity preference and anxiety. Shared, hands-free interactive media engaged individuals of diverse age and mobility. Conclusion: Shared opportunities for positive distraction in healthcare facilities are valuable, particularly hands-free interactive media.


Assuntos
Instituições de Assistência Ambulatorial/normas , Ansiedade/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais Pediátricos/normas , Multimídia , Jogos e Brinquedos , Adolescente , Criança , Feminino , Humanos , Masculino , Adulto Jovem
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