Clinical Innovation Leads to Improved Outcomes
Our Hospital Medicine Surgical Service (HMSS), led by Erin Shaughnessy, MD, has had dramatic growth in the number of patients served as our surgical partners have recognized the benefit of having a pediatric hospitalist manage the medical needs of their complex patients. In partnership with Orthopaedic Surgery, we have developed a Posterior Spinal Fusion postoperative protocol that has increased reliability of providing the best evidence-based care. We have also implemented a standardized, early postoperative respiratory care pathway for children receiving major hip or spine surgery. The pathway incorporates novel strategies to improve lung health in patients with neurologic impairment (such as cerebral palsy). This effort has improved patient outcomes - such as less time requiring extra oxygen and shorter hospitalizations - and increased family empowerment to perform respiratory care. Surgical hospitalist and Division faculty member, Joshua Schaffzin, MD, PhD, received a PLACE Outcomes Research Award to further his work aimed at reducing rates of surgical site infection. We also lead a collaborative group of physicians developing a pediatric venous thromboembolism (VTE) prophylaxis evidence-based care guideline.
Improving Hospital Discharge Timeliness
Delays in patient discharge can result in slower admissions and delayed or canceled surgeries. A multidisciplinary team, led by Christine White, MD, MAT, and Angela Statile, MD, has developed medically-ready discharge criteria, based on available evidence and expert consensus, for 11 common inpatient diagnoses. The criteria outline diagnosis-specific goals such as achieving “stable without supplemental oxygen for 6 hours” for patients admitted with bronchiolitis. The discharge criteria are embedded in admission order sets in the electronic medical record. Physicians modified the criteria as a patient’s clinical course evolved. Interventions then focused on four main areas: 1) key stakeholder buy-in and shared ownership; 2) pharmacy process redesign; 3) improving the timeliness of subspecialty consults; and 4) near real-time identification and mitigation of failures with data transparency. These changes were associated with an increase in the percentage of patients discharged within two hours of meeting their discharge goals from 42 percent at study start to 80 percent currently. Hospital lengths of stay for patients with one of these 11 conditions were reduced by 10 percent while readmission rates were unchanged. We estimate the shortened lengths of stay are saving almost $6 million per year.
Improving Pediatric Care Through Regional Partnerships
Our Division worked with Business Development to establish an institutional affiliation with Niswonger Children’s Hospital/Mountain States Health Alliance (MSHA) and the Department of Pediatrics of East Tennessee State University (ETSU)/Quillen College of Medicine in Johnson City, TN. The affiliation seeks to improve child health in East Tennessee by implementing a hospital medicine program led by Cincinnati Children’s, which also will serve as a platform for providing other tertiary services. The Niswonger Hospital Medicine Program will be led by a Cincinnati Children’s-employed Hospitalist Director, staffed by ETSU faculty, and supported by our Division for operational leadership, quality improvement infrastructure and experience. This structure is designed to provide more evidence-based, standardized, and data-driven patient care. In addition to spearheading these efforts, Craig Gosdin, MD, MSHA, has partnered with Niswonger staff to implement a clinical pathway to improve inpatient asthma care. Next steps include improving communication with primary care providers and discharge efficiency, and implementing family-centered rounds.