The Division of Hospital Medicine, and its precursor the General Inpatient Service, have a long tradition of innovation and early adoption of innovations, including family-centered rounds and evidence-based guidelines. Over the past year the tradition has accelerated. Division physicians have led four projects to improve the adoption of emerging evidence in a timely manner. These include earlier transition to oral antibiotics for osteomyelitis, use of probiotics for gastroenteritis, elimination of overuse of voiding cystourethrograms for first-time urinary tract infection, and use of narrower-spectrum antibiotics for community-acquired pneumonia. In each case, baseline performance was less than 10 percent and current performance has been sustained above 90 percent. Key leaders of this body of work include Michael Vossmeyer, MD, Joshua Schaffzin, MD, PhD, Michelle Parker, MD, Patrick Conway, MD, MSc, Karen Jerardi, MD, Dena Elkeeb, MD, Jeffrey Simmons, MD, MSc, Christine White, MD, MAT, Samir Shah, MD, MSCE, Amy Guiot, MD, Patrick Brady, MD, MSc, and Eric Kirkendall, MD.
In addition, and detailed further in the significant publications section, the Division has implemented and studied the impact of a novel bedside physician hand-off process at our Liberty campus where Division faculty and staff physicians provide direct care. Led by Craig Gosdin, MD, MSHA, this work has improved patient and nurse satisfaction and helped standardize clinical care.
Improving Pneumonia Care
Community-acquired pneumonia is the most common serious bacterial infection in children. Samir Shah, MD, Division director, co-authored the national pneumonia management guidelines (Clin Infect Dis 2011;53:e25-76). These guidelines were sponsored by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society and endorsed by the American Academy of Pediatrics and other leading academic societies. These guidelines provide the first evidence-based recommendations for the diagnosis and treatment of children with pneumonia in the United States.
The guideline recommends ampicillin or amoxicillin as first-line treatment for pneumonia. Fewer than 10 percent of children at Cincinnati Children’s had received these treatments when the guideline was published; children typically received “broad spectrum” antibiotics such as ceftriaxone, whose unnecessary use contributes to the development of antibiotic resistance. A team Cincinnati Children’s and community physicians, nurses, and pharmacists, led by Christine White, MD, and Lilliam Ambroggio, PhD, from Hospital Medicine, implemented a series of interventions that resulted in 100 percent of children with pneumonia receiving the recommended treatments.
Jeffrey Simmons, MD, associate director of clinical operations and quality, received a Clinical Care Achievement Award for his exceptional commitment to patient- and family-centered care, mentoring junior faculty, and developing innovative models of clinical care. As an example, Simmons partnered with colleagues in Pulmonology, General Pediatrics and Allergy to reduce re-admissions for acute asthma.
Michelle Parker, MD, was recognized at the 17th International Scientific Symposium on Improving Quality and Value in Health Care for her work leading evidence adoption at Cincinnati Children’s. Her project focused on increasing use of a probiotic, Lactobacillus, to treat acute gastroenteritis. In this study, Parker, Schaffzin, Conway, and Guiot used quality improvement methods to increase evidence-based prescribing from less than 1 percent to 100 percent for children hospitalized with acute gastroenteritis.
Samir Shah, Division director, was named inaugural Associate Editor of the Journal of the Pediatric Infectious Diseases Society and was promoted to Deputy Editor of the Journal of Hospital Medicine.