Nationwide Children's Hospital Approved Maintenance of Certification (MOC) Projects

The PFK Pediatric Asthma Collaborative

Partners for Kids, in conjunction with the American Academy of Pediatrics, will conduct a second collaborative program to assist practices in implementing the NHLBI/NAEPP asthma guidelines through a quality improvement approach. Past participants have demonstrated remarkable improvements in care for their asthma patients. Practices will receive support from PFK and Ohio Chapter of the AAP, plus quality improvement tools and resources to improve asthma care in the practice. The program is scheduled to begin in late August 2011. For more information please contact Physician leader: William Long, MD william.long@kidzdoc.com, and Steven Hersey, MD Steven.Hersey@nationwidechildrens.orgor Project manager: Christine O'Connor christine.oconnor@nationwidechildrens.org.

Increase Obesity Diagnosis in Nationwide Children’s Hospital Primary Care Center

Nationally obesity has become an epidemic problem for all including children. Studies show that a child who is obese at age 6 has a 25% chance of being obese as an adult, and a child who is obese at age 12 has a 75% chance of being obese as an adult. Obesity leads to a multitude of diseases ranging from diabetes to high blood pressure, from heart disease to depression. The best way to “treat” obesity is to prevent it. This involves teaching and promoting healthy lifestyles from birth. If prevention fails, intervention starts with identification of the obese child as early as possible so that treatment may be initiated.

• Physician Project Leader: William Cotton, MD

Decreasing the blood culture contamination rate in Nationwide Children’s Hospital Emergency Department

Blood cultures are drawn in pediatric patients to identify bacteremia and sepsis. Results of the cultures are used to direct therapy. Sometimes, a blood culture grows a contaminant. Unfortunately it is very difficult or impossible to differentiate initial growth of a skin contaminant such as staph epidermidis from a pathogen such as staph aureus. The potential of contaminants leads to longer hospital stays, unnecessary antibiotic therapy, and additional laboratory testing. As a result, the cost of blood culture contamination incurred by a hospital is many times that incurred by the laboratory. These patients need rechecks, repeat blood draws and sometimes antibiotic therapy for a few days until infection can be differentiated from contamination. Decreasing the number of false positive blood cultures should decrease the number of revisits and admissions for false positive cultures, decrease antibiotic administration for false positive cultures, decrease the number phone calls to families, and increase the positive predictive value of blood culture growth.

• Physician Project Leader: Jeremy Larson, MD

Reducing Staff Exposures to Pertussis in the Emergency Department

Pertussis can be a deadly disease in infants and is highly communicable. Central Ohio, along with other parts of the country, is currently experiencing an outbreak of Pertussis. Many patients seek care in our Emergency Department who has signs and symptoms that could be pertussis. Without proper isolation of these patients our staff is exposed and may transmit the disease to other patients and/or their own families. This project addresses ways to appropriately increase isolation of these patients at the earliest possible point in our system to decrease staff exposure, decrease the cost of prophylactic antibiotics and most importantly decrease further spread of the disease.

• Physician Project Leader: Leslie Mihalov, MD

Reduce Adverse Drug Events

ADE represent the largest single portion of our harm index and a majority of those ADE events occur in our Critical Care Areas (NICU, PICU, HEMATOLOGY). This ADE Collaborative (ADEQC) addresses ways to reduce the number of preventable ADEs per month that reach the patient and cause harm, decrease health care costs by avoiding ADEs and improving ADE prevention bundle compliance per participating unit using the IHI Model for Improvement.

• Physician Project Leader: Richard McClead, MD

Decrease ALOS for infants admitted to the Nationwide Children’s Hospital main campus NICU

Unnecessary and prolonged hospitalization exposes neonates to preventable harm such as hospital acquired infections, pressure ulcers, and medication errors. Prolonged hospitalization in the NICU also has an adverse effect on parents, siblings, and other family members. Moreover, prolonged hospitalization contributes to excessive healthcare costs. Thus, optimizing patient care services to reduce unnecessary hospitalization is an important quality initiative that will decrease preventable harm, reduce hospital costs and improve parent satisfaction.

• Physician Project Leader: Richard McClead, MD