PHM Quality Improvement Collaboratives An Update.

PHM Quality Improvement CollaborativesAn Update

Collaborative #1Co Chairs: Shannon Phillips, MD, MPHPaul Hain, MD

• Specific AIM:• We will reduce the percent of patient ID band errors at

hospitals in this collaborative by 50% by September 1, 2010.

Collaborative ColleaguesConsulting

• Monroe Carell Jr. Children's Hospital at Vanderbilt TN• Paul Hain, MD

Collaborative1. Cleveland Clinic Children’s Hospital OH

• Shannon Phillips, MD, MPH• Meredith Lahl, RN, MSN, CNS 

2. Denver Children’s Hospital CO • Dan Hyman, MD• Mariel Laire

3. New York Hospital Queens • Laurie Gordon, MD

4. Our Lady of the Lake Regional Medical Center LA• Steve Narang, MD• Tracie Major, APRN, CNS, CPN

5. James Whitcomb Riley Children’s Hospital IN • Michele Saysana, MD

6. Scottsdale Healthcare Hospitals AZ• John Pope, MD

• Morgan Stanley Children’s Hospital of NY Presbyterian• Anu Subramony, MD

• Presbyterian Intercommunity Hospital CA• Jeff Gill, MD

Results

18% 6%

Change Concepts• Raise awareness of safety risk for

• Staff• Parents/Patients

• Shared educational materials• Kinder, gentler ID bands

Collaborative #2Co Chairs:Mark Shen, MDJulia Shelburne,MD

• Specific Aim:

• Over the next 6 months, we will lead a quality improvement collaborative and achieve measureable improvement in the frequency AND timeliness of communication of patient information to the PCPs at discharge with the Goal of 90% of hospitalist discharges at each participating hospital will have documentation of communication with a PCP within 2 calendar days of actual discharge.

Participants1. Lora Bergert: Kapi`olani Medical Center, Honolulu2. Michael Bryant: USC Keck School of Medicine 3. David Cooperberg: St. Christopher’s, Philadelphia 4. Dan Coughlin: Hasbro Children’s, Providence5. Leah Mallory: Barbara Bush Children’s Hospital at Maine

Medical Center ,Portland6. Beth Robbins: Anne Arundel Medical Center, Annapolis7. Julia Shelburne: UT-Houston Medical School/Children’s

Memorial Hermann Hospital8. Mark Shen and Don Williams: Dell Children’s Medical Center,

Austin 9. Ann Vanden Belt: St. Joseph Mercy Hospital, Ypsilanti, MI10. Joyce Yang, Dan Hershey, and Erin Stucky: Rady Children’s

Hospital, San Diego

Results

Percent of discharges with documented communication with PCP within 2 calendar days of discharge, by month

Change Package• Obtain support of hospital leadership• Gather accurate contact information• Automate the process using IT solutions• Provide targeted and timely feedback to physicians • Create incentives for attending physicians

Collaborative #3Co Chairs: Matt Garber, MDBeth Robbins, MD

• Specific AIM:• Reduce the use of inhaled short-acting bronchodilators in

children hospitalized with bronchiolitis

• To reduce the number of bronchiolitis patients treated with any bronchodilator medication by 20% from that institution’s baseline or to <=30%

• To reduce the average total number of treatments per patient by 50% from that institution’s baseline

Participants• Elizabeth L. Robbins, Anne Arundel Medical Center• Jeanann P. Pardue MD, Director of CPG Inpatient Service

East TN Children's Hospital• Michele Lossius, MD, FAAP Assistant Professor, UF-

COM• Eric Balighian, Pediatric Hospitalist, St. Agnes Hospital• John A Pope MD, MPH, Physician Director, Pediatric

Services, Scottsdale Healthcare Hospitals• Matthew Garber, MD,FAAP, FHM, Assistant Professor

USC-SOM, Director Pediatric Hospitalists

% Bronchodilator Use: Preliminary DataAverage of 25% decrease

% of Bronchodilator doses/pt: Prel DataAverage of 47% Decrease

Change package• A Respiratory Therapists Driven Protocol

• Communication at every level – nurse, RT, PCP, ED attendings, other hospitalists, learners - is needed to address cultural barriers

• New partnerships with RT, RN, IT, CQI, and administration are also needed to address technical barriers

Next Steps for PHM QI Collaboratives..

• We have “tested the concept”• PHM Physicians Can Collaborate to Improve Care• Next Challenge

• Sustaining and Disseminating • Finding a “home” for funding and infrastructure• MOC for Pediatric Hospitalists ?