Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Erich K. Batra ◽  
Mary Lewis ◽  
Deepa Saravana ◽  
Tammy E. Corr ◽  
Carrie Daymont ◽  
...  
Keyword(s):  
Control Charts ◽  
The United States ◽  
Safe Sleep ◽  
Statistical Process ◽  
Children's Hospital ◽  
Caregiver Education ◽  
Infant Safe Sleep ◽  
Children’S Hospital ◽  
Statistical Process Control Charts ◽  
Sleep Environment

BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children’s hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children’s hospital.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

2021 ◽  
pp. 019459982110133
Author(s):  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Cecelia E. Schmalbach
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Control Charts ◽  
Neck Surgery ◽  
Resident Training ◽  
Statistical Process ◽  
Ensure Patient Safety ◽  
Statistical Process Control Charts ◽  
The Individual ◽  
The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

Evaluating Safe Sleep Practices in an Academic Children's Hospital

2021 ◽  
Author(s):  
Kristina M. Nazareth-Pidgeon ◽  
Lauren Chamberlain ◽  
Sophie K. Shaikh
Keyword(s):  
Safe Sleep ◽  
Children's Hospital ◽  
Children’S Hospital

Hospital Use Patterns for Children in the United States, 1983 and 1984

PEDIATRICS ◽  
1987 ◽  
Vol 80 (4) ◽  
pp. 481-490 ◽  
Author(s):  
Lola Jean Kozak ◽  
Catherine Norton ◽  
Margaret McManus ◽  
Eileen McCarthy
Keyword(s):  
Health Status ◽  
Hospital Discharge ◽  
Discharge Rate ◽  
The United States ◽  
National Hospital Discharge Survey ◽  
Children's Hospital ◽  
Use Patterns ◽  
Discharge Rates ◽  
Children’S Hospital ◽  
Hospital Use

The hospital discharge rate of children less than 15 years of age in the United States declined 12% from 1983 to 1984. This was the first time in the 20-year history of the National Hospital Discharge Survey that there was a statistically significant decrease in children's hospital discharge rates in a 1-year period. The change occurred during a period when prospective hospital payment systems were introduced and when prepaid group health plans and alternative systems of providing health care were expanding. The unprecedented decrease in children's hospital use was evaluated using data from the National Hospital Discharge Survey. This is a continuous survey in which data from a national sample of medical records of discharged patients are collected. Children's hospital use rates were reviewed by age, sex, region, and expected principal source of payment. Significant decreases in discharge rates were found for the age group 1 to 4 years and for all children with private insurance. The patterns and changes in hospital use by diagnostic category were also investigated. The major finding was a 19% decrease in children's discharge rate for diseases of the respiratory system. Mortality statistics and data from the National Health Interview Survey were evaluated for indications of changes in children's health status or use of physician services accompanying the decline in hospital use. Although there were fewer deaths due to respiratory diseases for children less than 5 years of age in 1984 than in 1983, most measures of health status were unchanged. The only significant change in physician use was a decrease in the percentage of acute conditions that were medically attended, also among children less than 5 years of age. It is important to continue monitoring children's hospital use patterns, as well as their health status and use of alternative health services, to further assess the impact of changes in the organization and financing of health services.

DIAGNOSTIC INERTIA

PEDIATRICS ◽  
1961 ◽  
Vol 28 (5) ◽  
pp. 695-696
Author(s):  
R. J. MCKAY
Keyword(s):  
United States ◽  
Patient Care ◽  
The United States ◽  
Interim Report ◽  
Children's Hospital ◽  
Medical Centers ◽  
Pediatric Education ◽  
Children’S Hospital ◽  
Pediatric Services

In this issue of Pediatrics the article entitled "A New Design for Patient Care and Pediatric Education in a Children's Hospital: An Interim Report," by Green and Segar, represents a challenging approach to problems that are of increasing concern to pediatric educators and pediatric services of medical centers throughout the United States. It should be emphasized that the authors' plan is a proposed solution to the problems involved, and that the question as to whether it will constitute an answer will have to await analysis not only of their results but of the results of other approaches to the same problems.

Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Olivia Ostrow ◽  
Deena Savlov ◽  
Susan E. Richardson ◽  
Jeremy N. Friedman
Keyword(s):  
Control Charts ◽  
Respiratory Infections ◽  
Audit And Feedback ◽  
Improvement Strategy ◽  
Statistical Process ◽  
Process Control Charts ◽  
Statistical Process Control Charts ◽  
Viral Testing ◽  
Return Visits ◽  
Viral Respiratory Infections

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

DEFECTIVE STEROIDAL BIOGENESIS IN CONGENITAL ADRENAL HYPERPLASIA

PEDIATRICS ◽  
1958 ◽  
Vol 21 (4) ◽  
pp. 661-672
Author(s):  
Alfred M. Bongiovanni ◽  
Walter R. Eberlein
Keyword(s):  
Research Work ◽  
Assistant Professor ◽  
The United States ◽  
University Of Pennsylvania ◽  
Rockefeller Institute ◽  
Children's Hospital ◽  
Research Division ◽  
Children’S Hospital ◽  
The University

Dr. Alfred M. Bongiovanni is a young man who started research work as an investigator at the Marine Biological Laboratory, Woods Hole, Massachusetts, even before he received his B.S. degree from Villanova College in 1940. While at Villanova, Dr. Bongiovanni received the Kolmer Medal for Excellence in Science. In 1943 he received his M.D. from the University of Pennsylvania, following which he immediately served a 2-year tour of duty in the United States Navy. After discharge from the Navy, he filled residencies at the Children's Hospital of Philadelphia from 1947 to 1949. During the years 1949 and 1950, Dr. Bongiovanni served as Assistant Physician at the Rockefeller Institute in New York and in 1950-51 returned to the Children's Hospital of Philadelphia as Assistant Director of Clinics. In 1951 he was appointed the National Foundation of Infantile Paralysis Fellow to the Research Division of the Children's Hospital of Philadelphia. New opportunities and promotions quickly followed with an appointment as Assistant Professor of Pediatrics at Johns Hopkins in 1952; Senior Research Associate in the Pediatric Endocrine Division and Assistant Professor of Pediatrics at the University of Pennsylvania in 1954; and in 1955 Associate Professor of Pediatrics at the same university. Dr. Bongiovanni is a Diplomate of the American Board of Pediatrics and a member of the Editorial Board of the American Journal of Medical Sciences and of numerous professional societies. In 1956 Dr. Bongiovanni received the Ciba Award. Dr. Bongiovanni has been author of about 50 articles, the great majority of which are on endocrinology and at least 23 of them with Dr. Eberlein, who is the co-recipient with Dr. Bongiovanni of this Award, as a co-author.

Statistical Tests of Type I Error

2021 ◽  
pp. 90-120
Author(s):  
Charles Auerbach
Keyword(s):  
Control Charts ◽  
Sampling Error ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Data Sets ◽  
Chi Square ◽  
Statistical Process ◽  
Incorrect Decision ◽  
Type 1 Error ◽  
Statistical Process Control Charts

This chapter covers tests of statistical significance that can be used to compare data across phases. These are used to determine whether observed outcomes are likely the result of an intervention or, more likely, the result of sampling error or chance. The purpose of a statistical test is to determine how likely it is that the analyst is making an incorrect decision by rejecting the null hypothesis, that there is no difference between compared phases, and accepting the alternative one, that true differences exist. A number of tests of significance are presented in this chapter: statistical process control charts (SPCs), proportion/frequency, chi-square, the conservative dual criteria (CDC), robust conservative dual criteria (RCDC), the t test, and analysis of variance (ANOVA). How and when to use each of these are also discussed, and examples are provided to illustrate each. The method for transforming autocorrelated data and merging data sets is discussed further in the context of utilizing transformed data sets to test of Type 1 error.

Analyzing Group Data

2021 ◽  
pp. 121-142
Author(s):  
Charles Auerbach
Keyword(s):  
Control Charts ◽  
Type I Error ◽  
Statistical Significance ◽  
Data Sets ◽  
Type I ◽  
Chi Square ◽  
Statistical Process ◽  
Incorrect Decision ◽  
Group Data ◽  
Statistical Process Control Charts

This chapter covers tests of statistical significance that can be used to compare data across phases. These are used to determine whether observed outcomes are likely the result of an intervention or, more likely, the result of chance. The purpose of a statistical test is to determine how likely it is that the analyst is making an incorrect decision by rejecting the null hypothesis and accepting the alternative one. A number of tests of significance are presented in this chapter: statistical process control charts (SPCs), proportion/frequency, chi-square, the conservative dual criteria (CDC), robust conservative dual criteria (RCDC), the t test, and analysis of variance (ANOVA). How and when to use each of these are also discussed. The method for transforming autocorrelated data and merging data sets is discussed. Once new data sets are created using the Append() function, they can be tested for Type I error using the techniques discussed in the chapter.

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