Defining Benchmarks in Pediatric Burn Care: Inception of the Pediatric Injury Quality Improvement Collaborative

Abstract Pediatric burn care is highly variable nationwide. Standardized quality and performance benchmarks are needed for guiding performance improvement within pediatric burn centers. A network of pediatric burn centers was established to develop and evaluate pediatric-specific best practices. A multi-disciplinary team including pediatric surgeons, nurses, advanced practice providers, pediatric intensivists, rehabilitation staff, and child psychologists from five pediatric burn centers established a collaborative to share and compare performance improvement data, evaluate outcomes, and exchange best care practices. In December 2016, the Pediatric Injury Quality Improvement Collaborative (PIQIC) was established. PIQIC members chose quality improvement indicators, drafted and approved a memorandum of understanding (MOU), data use agreement (DUA) and charter, formalized the multidisciplinary membership, and established a steering committee. Since inception, PIQIC has conducted monthly teleconferences and biannual in-person or virtual group meetings. A centralized data repository has been established where data is collated and analyzed for benchmarking in a blinded fashion. PIQIC has shown the feasibility of multi-institutional data collection, implementation of performance improvement metrics, publication of research, and enhancement of aggregate and institution-specific pediatric burn care.

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108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.112 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S72-S73

Author(s):

Kelli N Patterson ◽

Kyle Horvath ◽

Amanda Onwuka ◽

Renata Fabia ◽

Sheila Giles ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Body Surface Area ◽

Quality Improvement Collaborative ◽

Burn Care ◽

Pediatric Injury ◽

Total Body

Abstract Introduction Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn. Methods Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio. Results Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days. Conclusions These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.

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298 The Pediatric Injury Quality Improvement Collaborative (PIQIC): A Quality Improvement Initiative between Five Pediatric Burn Centers

Journal of Burn Care & Research ◽

10.1093/jbcr/irz013.214 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

pp. S126-S126 ◽

Cited By ~ 1

Author(s):

D Stewart ◽

S Ziegfeld ◽

R Burd ◽

R Thakkar ◽

P Aguayo ◽

...

Keyword(s):

Quality Improvement ◽

Quality Improvement Initiative ◽

Quality Improvement Collaborative ◽

Burn Centers ◽

Pediatric Injury

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Building the First Statewide Quality Improvement Collaborative, the CPQCC: A Historic Perspective

Children ◽

10.3390/children7100177 ◽

2020 ◽

Vol 7 (10) ◽

pp. 177

Author(s):

Jeffrey B. Gould

Keyword(s):

Quality Improvement ◽

Performance Improvement ◽

Health Professionals ◽

Neonatal Intensive Care ◽

Perinatal Care ◽

Quality Improvement Collaborative ◽

Public And Private ◽

Public Health Professionals ◽

Quality And Outcomes ◽

And Performance

The California Perinatal Quality Improvement Collaborative (CPQCC), founded in 1997, was the country’s first statewide perinatal quality improvement collaborative. Our goal was to improve the quality and outcomes of perinatal healthcare in California by developing a collaborative network of public and private obstetric and neonatal providers, insurers, public health professionals, and business groups to support a system for benchmarking and performance improvement activities for perinatal care. In this presentation, we describe how viewing the CPQCC as a complex value-driven organization, committed to identifying and addressing the needs of both its stakeholder partners and neonatal intensive care unit (NICU) members, has shaped the course of its development.

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Length of Stay per Total Body Surface Area Burn Relative to Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study

Journal of Burn Care & Research ◽

10.1093/jbcr/irab212 ◽

2021 ◽

Author(s):

Kelli N Patterson ◽

Amanda Onwuka ◽

Kyle Z Horvath ◽

Renata Fabia ◽

Sheila Giles ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Total Body Surface Area ◽

Common Mechanism ◽

Quality Improvement Collaborative ◽

Pediatric Injury ◽

Total Body

Abstract Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients are often limited to single institutions and are grouped in ranges of TBSA burn which lacks specific detail to counsel patients and families. A LOS to TBSA burn ratio of 1 has been widely accepted but not validated with multi-institution data. The objective of this study is to describe the current relationship of LOS per TBSA burn and LOS per TBSA burn relative to burn mechanism with the use of multi-institutional data. Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for patients across five pediatric burn centers from July 2018-September 2020. LOS per TBSA burn ratios were calculated. Descriptive statistics and generalized linear regression which modeled characteristics associated with LOS per TBSA ratio are described. Among the 1267 pediatric burn patients, the most common mechanism was scald (64%), followed by contact (17%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.2 (SD 2.1). In adjusted models, scald burns and chemical burns had similar LOS/TBSA burn ratios of 0.8 and 0.9, respectively, while all other burns had a significantly higher LOS/TBSA burn ratio (p<0.0001). LOS/TBSA burn ratios were similar across races, although Hispanics had a slightly higher ratio at 1.4 days. These data establish a multi-institution LOS per TBSA ratio across PIQIC centers and demonstrate significant variation in the LOS per TBSA burn relative to the burn mechanism sustained.

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Partnering to develop a talent pipeline for emerging health leaders in operations research

Healthcare Management Forum ◽

10.1177/0840470416677601 ◽

2017 ◽

Vol 30 (3) ◽

pp. 146-150

Author(s):

Alfred Ng ◽

Carly Henshaw ◽

Michael Carter

Keyword(s):

Quality Improvement ◽

Performance Improvement ◽

Operations Research ◽

Central Office ◽

Talent Management ◽

Healthcare Engineering ◽

And Performance ◽

The University ◽

Targeted Approach ◽

Internal Capacity

In initiating its first central office for Quality Improvement (QI), The Scarborough Hospital (TSH) sought to accelerate momentum towards achieving its “Quality and Sustainability” strategic priority by building internal capacity in the emerging QI specialty of operations research. The Scarborough Hospital reviewed existing models of talent management in conjunction with Lean and improvement philosophies. Through simple guiding principles and in collaboration with the University of Toronto’s Centre for Healthcare Engineering, TSH developed a targeted approach to talent management for Operations Research (OR) in the Office of Innovation and Performance Improvement, reduced the time from staffing need to onboarding, accelerated the development of new staff in delivering QI and OR projects, and defined new structures and processes to retain and develop this group of new emerging health leaders.

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Residents' satisfaction with multi-purpose services

Australian Health Review ◽

10.1071/ah080349 ◽

2008 ◽

Vol 32 (2) ◽

pp. 349 ◽

Cited By ~ 1

Author(s):

Judith K Anderson ◽

John B Rae ◽

Linda E Grenade ◽

Duncan P Boldy

Keyword(s):

Quality Improvement ◽

Performance Improvement ◽

New South ◽

Project Design ◽

Management Styles ◽

Resident Satisfaction ◽

Work Processes ◽

Staff Members ◽

South Wales ◽

And Performance

Aim: To establish a system for measuring resident satisfaction in multi-purpose services, benchmarking and performance improvement. Setting: Six multi-purpose services in rural New South Wales were involved in the project. Design: Residents were surveyed and the results benchmarked. Benchmarking included a comparison of results along with an exploration of work processes across participating sites. This preceded quality improvement activities conducted by individual multi-purpose services. Resident surveys were repeated and staff and managers interviewed. Outcomes: Benchmarking was a useful method for identifying performance leaders and enabling the dissemination of better practice. The majority of staff members were comfortable with the PDSA (Plan, Do, Study, Act) quality improvement cycle to guide their improvement efforts. The ability of staff to complete quality improvement cycles was related to the management styles of their supervisors. Resident satisfaction was related to the understanding and confidence of staff. Conclusion: A resident satisfaction survey can provide the direction for effective quality improvement activities. Benchmarking results with other sites not only empowers staff members at those sites recognised as leaders, but can also stimulate dissemination of leading practice. Management styles which empower staff enhance their ability to implement quality improvement projects.

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