A Prospective Cohort Quality Improvement Study to Reduce the Time to Antibiotics for New Fever in Neutropenic Pediatric Oncology Inpatients

2015 ◽  
Vol 63 (1) ◽  
pp. 112-117 ◽  
Author(s):  
Adam L. Green ◽  
Joanna Yi ◽  
Natalie Bezler ◽  
Yana Pikman ◽  
Venée N. Tubman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Prospective Cohort ◽  
Time To Antibiotics ◽  
Cohort Quality

Preventing Excess Narcotic Prescriptions in New Robotic Surgery Discharges: The PENN Prospective Cohort Quality Improvement Initiative

2020 ◽  
Vol 34 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Ruchika Talwar ◽  
Leilei Xia ◽  
Juan Serna ◽  
James Ding ◽  
Daniel J. Lee ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Robotic Surgery ◽  
Prospective Cohort ◽  
Quality Improvement Initiative ◽  
Cohort Quality

scholarly journals A Quality Improvement Initiative: Improving Time-to-Antibiotics for Pediatric Oncology Patients with Fever and Suspected Neutropenia

2020 ◽  
Author(s):  
David E Kram ◽  
Kia Salafian ◽  
Sarah M Reel ◽  
Emily Nance Johnson ◽  
Brianna Borsheim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Pediatric Oncology ◽  
Pediatric Emergency ◽  
Quality Improvement Initiative ◽  
Pediatric Emergency Department ◽  
Intervention Period ◽  
Oncology Patients ◽  
Time To Antibiotics ◽  
Antibiotic Delivery

ABSTRACTBackgroundThere is a high risk for adverse outcomes in immunocompromised, neutropenic pediatric oncology patients with fever if antibiotics are not received in a timely manner. As the absolute neutrophil count is typically unknown at the onset of fever, rapid antibiotic administration for all pediatric oncology patients with fever and suspected neutropenia is critical.Local ProblemDespite efforts over the years to meet the standard of time-to-antibiotic delivery to within 60 minutes of arrival, audits revealed a prolonged and wide-ranging time-to-antibiotics in our pediatric emergency department.MethodsWe conducted a quality improvement initiative to reduce the time to antibiotic delivery for this high risk patient population. The setting was a pediatric emergency department in an academic tertiary care hospital. We assembled a multidisciplinary team to apply quality improvement methods to understand the problem, implement interventions, and evaluate the outcomes.InterventionsWe targeted delays in patient triage, delays in antibiotic ordering, delays in antibiotic choice, and delays in bedside indwelling Port-a-Cath accessing procedure. Among other interventions, we instituted three unique measures: ceftriaxone was administered to all pediatric oncology patients with suspected neutropenia and fever; a system of ordering antibiotics that was driven by the ED pharmacist obtaining a verbal order from the ED attending; and a nurse-driven order set triggered by a unique triage category which empowered nurses to access a patient’s central line, draw and send specified blood work, and deliver an intravenous antibiotic, all potentially before an ED provider sees the patient.ResultsOver a sustained 3 year period of time, the percentage of febrile oncology patients with suspected neutropenia who met the target time-to-antibiotic delivery rose from 51% to 96%. The mean time-to-antibiotic delivery fell from 58 minutes in the pre-intervention period to 28 minutes in the post-intervention period.ConclusionsThe interventions implemented by the multidisciplinary team, using quality improvement methodology, successfully improved the percentage of febrile oncology patients receiving antibiotics within 60 minutes of arrival to a pediatric emergency department.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

scholarly journals A Quality Improvement Initiative to Decrease Time to Antibiotics for Children with Intestinal Failure, Fever, and a Central Line

2018 ◽  
Vol 3 (4) ◽  
pp. e090 ◽  
Author(s):  
Selena Hariharan ◽  
Ethan A. Mezoff ◽  
Christopher E. Dandoy ◽  
Yue Zhang ◽  
Janis Chiarenzelli ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Intestinal Failure ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Time To Antibiotics

scholarly journals Successful Implementation of a Pediatric Early Warning Score in a Resource-Limited Pediatric Oncology Hospital in Guatemala

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 60s-60s
Author(s):  
Asya Agulnik ◽  
Dora Judith Soberanis Vasquez ◽  
Jose Emigdio García Ortiz ◽  
Lupe Nataly Mora Robles ◽  
Ricardo Mack ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Early Warning ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
Early Warning Score ◽  
Level Of Care ◽  
Successful Implementation ◽  
Oncology Patients ◽  
Resource Limited

Abstract 25 Background: Hospitalized pediatric oncology patients are at high risk for clinical decline and mortality, particularly in resource-limited settings. Pediatric Early Warning Scores (PEWS) are commonly used to aid with early identification of clinical deterioration; however, these scores have never been studied in oncology patients in low-resource settings. We describe the successful implementation of a modified PEWS at Unidad Nacional de Oncología Pediátrica (UNOP), a national pediatric oncology hospital in Guatemala. Methods: The PEWS used at Boston Children's Hospital (BCH) was modified through key informant meetings at UNOP, adjusting for practice variations between the two hospitals. After an initial pilot of the tool, the PEWS was implemented in all non-ICU inpatient areas at UNOP (60 beds with about 2,000 admissions/year). During implementation, systems were created to monitor errors in calculating PEWS, patient transfers to a higher level of care, and high PEWS scores for ongoing quality improvement. Results: Hospital-wide implementation occurred over 6 months, when 113 nurses were trained in the PEWS tool and algorithm. Compliance with PEWS performance and documentation was 100% by the end of the implementation period, with 300 to 400 PEWS measured daily and less than 10% errors. Monitoring of PEWS results reports an average of 5 high PEWS per week with 30% transferring to a higher level of care. Among patients requiring ICU transfer, 86% had an abnormal PEWS prior to transfer, which is similar to results at BCH (90%). Staff surveys showed a high degree of satisfaction with PEWS (4.6/5) and minimal difficulty using the score (2.3/5) (n=67). Conclusions: We describe the successful implementation of a PEWS in a pediatric oncology hospital in Guatemala. This work demonstrates that PEWS is a feasible, well-accepted, and low-cost quality improvement measure in this resource-limited setting. We now plan to evaluate the effects of this implementation on patient care and outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Using Quality Improvement Methodology to Implement Survivorship Care Plans

2020 ◽  
Vol 16 (1) ◽  
pp. e117-e123 ◽  
Author(s):  
Christine Moore Smith ◽  
Debra L. Friedman ◽  
Barron L. Patterson
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Curative Intent ◽  
Accreditation Standard ◽  
Care Plans ◽  
Cancer Registry Data ◽  
Time Period ◽  
American College Of Surgeons

PURPOSE: Accreditation requirements for cancer centers by the American College of Surgeons’ Commission on Cancer have included provision of survivorship care plans (SCPs) to patients treated with curative intent soon after completion of therapy. These were traditionally provided in a dedicated survivorship clinic for our pediatric oncology patients later in the survivorship time period. Our goal was to increase timely provision of SCPs to eligible patients in our acute care pediatric oncology clinic and to have this serve as a bridge to longer-term survivorship care. METHODS: Our pediatric oncology clinic used quality improvement methodology to implement a process for creation of SCPs. We defined eligible patients on the basis of curative intent. Cancer registry data were queried to find eligible patients, and chart reviews were done weekly. A P chart and run chart were used to monitor our process for creation of plans and overall completion rate, respectively. RESULTS: During the intervention period, we increased the percentage of eligible patients with an SCP from 28% on June 30, 2017, to 53% by December 31, 2017. Since that time, we have continued to increase the percentage of patients with SCPs, reaching 69% by June 30, 2019. CONCLUSION: By using quality improvement methodology, our pediatric oncology clinic was able to change its clinical practice and implement a sustainable process for provision of SCPs and survivorship planning earlier in the post-treatment course, and meet the Commission on Cancer accreditation standard.

A Novel Experiential Quality Improvement Training Program During Residency Improves Quality Improvement Confidence and Knowledge: a Prospective Cohort Study

2020 ◽  
Vol 44 (3) ◽  
pp. 267-271 ◽  
Author(s):  
Samuel J. Ridout ◽  
Kathryn K. Ridout ◽  
Brian Theyel ◽  
Lisa M. Shea ◽  
Lauren Weinstock ◽  
...  
Keyword(s):  
Cohort Study ◽  
Quality Improvement ◽  
Training Program ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Experiential Quality
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