- Email: [email protected]
Improving Hospital Communication Through Standardization of Paging Practices
ACADEMIC PEDIATRICS
Response Code placed on their hospital ID that was linked to Medhub. An iPad was loaded with codeReadr software and was placed at the door for each morning and noon conference. Residents scanned their code, which automatically recorded attendance in MedHub. The scanner would prevent anyone from recording attendance if they arrived more than 50% of the way through the conference. Conference attendance data was recorded four days a week for three months (Sept 15-Dec 15) and compared to the previous three months (Jun 15-Sept 15) before the intervention and to the same time period the previous academic year (Sept 14-Dec 14). MEASURES: Measures include number of recorded attendees at each conference and average conference attendance. RESULTS: After the intervention, average Morning Conference recorded attendance increased by 43% (p-value <0.005), and Noon Conference recorded attendance increased by 16% (0.02). When comparing the average recorded conference attendance from the same time period in the 2014 versus 2015 academic year, Morning Conference attendance increased by 9.7 residents a 287% increase(<0.005) and Noon Conference increased by 7.2 a 115% increase(<0.005). CONCLUSIONS AND NEXT STEPS: There was a significant increase in recorded attendance at both Morning and Noon Conference after implementation of electronic attendance tracking. Manually entering attendance data into MedHub was also eliminated from a coordinators tasks. More data needs to be collected to measure sustainability of increase and expansion to all conferences. 41. COMMUNICATION IS KEY: USING THE OUTPATIENT ELECTRONIC MEDICAL RECORD (OEMR) MESSAGING SYSTEM TO COMMUNICATE ABOUT PATIENT CARE Mahesh Shrestha, MD, Sonia Desikan, MD, Lewis Krata, MD, Emmanuel Unachukwu, MD, Guiqing Huang, MD, Kimberly J. Matthews, MD, Mebratu Daba, MD, Sasikumar Cheruveettara, MD, Vahid Khajoee, MD, Brooklyn Hospital Center, Brooklyn, NY BACKGROUND: Continuity of care is a primary objective of general pediatrics and reflects quality patient care. For every patient admitted to the pediatric floor, the admitting resident’s responsibility is to contact the patient’s pediatrician (PMD) to inform about the admission and management plan. For patients with PMD’s from our continuity clinic, a brief message is sent using the
ABSTRACTS
e19
OEMR messaging system. This allows for simple in house communication which, in turn, contributes to effective continuity of care. Our baseline data showed that messaging to the PMD was less than 20% at the onset of the Quality Improvement (QI) Project. AIM STATEMENT: We planned to increase OEMR messaging about inpatient admissions to the patient’s PMD to 90% over 10 months. INTERVENTIONS: The 1st intervention was an email sent to all residents informing about the OEMR messaging system. The 2nd intervention was a discussion with all residents working on the pediatric floor about how to use the OEMR messaging system. The 3rd intervention included reminder notes about messaging the PMD on all computers on the pediatric floor. MEASURES: Every month, the message section was checked in the OEMR for each admitted clinic patient to see if a message was sent to the PMD. We measured the % of PMD’s notified of patient admissions at two-week intervals and made a run chart (shown above). RESULTS: Starting from a baseline of 20% OEMR messaging in July 2015, our next data point increased to 43% but dropped to 0 % by the 2nd week of September. We initiated our 1st intervention then and saw improvement to 46%, followed by a dip before increasing again to 88% in December, 2015. We then started our 2nd intervention, but we saw a drop to 38%. We made the 3rd intervention the 2nd week of January and then saw a gradual improvement to 100% before leveling off to 75% at the conclusion of the QI project. CONCLUSIONS AND NEXT STEPS: Our QI project highlighted that teamwork, identifying problems early and intervening consistently can bring progressive improvement in communication about patient care. A barrier was that there is a separate inpatient and outpatient EMR, requiring consistent prompting to use the messaging system. Making it part of the admission checklist may help with consistency of messaging in the future. 42. IMPROVING HOSPITAL COMMUNICATION THROUGH STANDARDIZATION OF PAGING PRACTICES Rachel M. Weigert, MD, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, Anna Schmitz, MD, Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, WI
e20
ABSTRACTS
ACADEMIC PEDIATRICS
Winner - APPD 2016 QI Project Award 43. WATCHER INITIATIVE DECREASES UNSAFE TRANSFERS TO A HIGHER LEVEL OF CARE Melanie M. Smith, DO, Maryanne M. Chumpia, MD, Lindsey A. Wargo, MD, Mark Bugnitz, MD, University of Tennessee, Memphis, TN
BACKGROUND: Paging is a primary mode of communication in hospitals, though it is asynchronous and often inconsistent. Children’s Hospital of Wisconsin (CHW) does not have a standardized paging format with variation in practice leading to staff dissatisfaction as well as roughly 6 reported patient care incidents per year resulting from pager related communication errors. AIM STATEMENT: Our Primary Aims were 1) create a standardized format designed to increase pages containing sender’s full name, call-back number, patient name, room number, and urgency wording to a goal of 90% for each element, and 2) improve provider ratings of the quality of paging communication with 80% of respondents rating paging satisfaction as excellent by January 2017. INTERVENTIONS: Interventions to date have included verbal announcements presented hospital-wide to residents and nursing staff, orientation material on paging etiquette, and posting of informational flyers were posted hospital between October and December 2015. MEASURES: Outcome Measures for this project include percent of pages containing each key element, rating of provider satisfaction with paging communication, and the frequency of patient safety events related to paging tracked over time. Process measures include ratings of timeliness and appropriateness of response to pages measured via survey, and frequency of pages including 5-6/6 critical elements. Balancing measures include measure of number of pages sent per day and paging satisfaction. RESULTS: Preliminary analysis revealed that respondents sent an average of 5-15 pages per day and rated paging communication as intermediate/good (3.3/5 point scale). There was an improvement in frequency of inclusion of 6/6 critical elements and inclusion of patient’s room number. Evaluation of other critical elements demonstrates stable or declining inclusion to date. CONCLUSIONS AND NEXT STEPS: After initial interventions aimed at improving the quality of paging communication in our hospital using a standardized format there are some early signs of improvement. Reaching the goal of widespread use of a standardized paging format will likely require multiple targeted interventions to reach all providers involved and achieve sustainable culture change. With further interventions and data collection, we hope to show standardized paging etiquette improves the clarity of communication and thereby both provider satisfaction and patient care.
BACKGROUND: Unrecognized clinical deterioration is a serious safety issue, and inability of care teams to promptly identify decompensating patients often leads to preventable undesirable outcomes. In an effort to reduce the number of poor clinical outcomes, we referenced an existing model at Cincinnati Children’s Hospital where huddles were used to identify “watchers” and prevent “unrecognized situation awareness failure events” (UNSAFE). We modified their system to fit our hospital’s floorbased inpatient setting. UNSAFE transfers include patients who required intubation, vasopressors, or >/¼ 3 fluid boluses either before or within one hour after transfer to a higher level of care. AIM STATEMENT: Our goal was to decrease the number of UNSAFE transfers from the targeted inpatient floor(s) to an ICU setting by 50% over a 6-month period. INTERVENTIONS: In May 2015, we asked residents and nurses to identify “watchers” based on defined criteria. This was reported in a daily safety brief. In July, we piloted twice daily huddles on an inpatient floor and have been implementing them on the remaining floors since that time. These huddles include a nursing patient care coordinator, supervising resident(s), and respiratory therapist. The huddles occur twice daily to communicate a plan for intervention and expected outcome within a designated time frame. This information is then disseminated to the bedside nurse and intern, who follow up on the outcome. MEASURES: We evaluated the number of UNSAFE transfers, as well as deaths on the floor, compared to the total number of transfers to an ICU setting. RESULTS: Prior to starting the daily safety brief in May, the percentage of UNSAFE transfers to a higher level of care was 14% over the previous 16 months. Our first intervention resulted in a 61% decrease in UNSAFE transfers. After our second
Response Code placed on their hospital ID that was linked to Medhub. An iPad was loaded with codeReadr software and was placed at the door for each morning and noon conference. Residents scanned their code, which automatically recorded attendance in MedHub. The scanner would prevent anyone from recording attendance if they arrived more than 50% of the way through the conference. Conference attendance data was recorded four days a week for three months (Sept 15-Dec 15) and compared to the previous three months (Jun 15-Sept 15) before the intervention and to the same time period the previous academic year (Sept 14-Dec 14). MEASURES: Measures include number of recorded attendees at each conference and average conference attendance. RESULTS: After the intervention, average Morning Conference recorded attendance increased by 43% (p-value <0.005), and Noon Conference recorded attendance increased by 16% (0.02). When comparing the average recorded conference attendance from the same time period in the 2014 versus 2015 academic year, Morning Conference attendance increased by 9.7 residents a 287% increase(<0.005) and Noon Conference increased by 7.2 a 115% increase(<0.005). CONCLUSIONS AND NEXT STEPS: There was a significant increase in recorded attendance at both Morning and Noon Conference after implementation of electronic attendance tracking. Manually entering attendance data into MedHub was also eliminated from a coordinators tasks. More data needs to be collected to measure sustainability of increase and expansion to all conferences. 41. COMMUNICATION IS KEY: USING THE OUTPATIENT ELECTRONIC MEDICAL RECORD (OEMR) MESSAGING SYSTEM TO COMMUNICATE ABOUT PATIENT CARE Mahesh Shrestha, MD, Sonia Desikan, MD, Lewis Krata, MD, Emmanuel Unachukwu, MD, Guiqing Huang, MD, Kimberly J. Matthews, MD, Mebratu Daba, MD, Sasikumar Cheruveettara, MD, Vahid Khajoee, MD, Brooklyn Hospital Center, Brooklyn, NY BACKGROUND: Continuity of care is a primary objective of general pediatrics and reflects quality patient care. For every patient admitted to the pediatric floor, the admitting resident’s responsibility is to contact the patient’s pediatrician (PMD) to inform about the admission and management plan. For patients with PMD’s from our continuity clinic, a brief message is sent using the
ABSTRACTS
e19
OEMR messaging system. This allows for simple in house communication which, in turn, contributes to effective continuity of care. Our baseline data showed that messaging to the PMD was less than 20% at the onset of the Quality Improvement (QI) Project. AIM STATEMENT: We planned to increase OEMR messaging about inpatient admissions to the patient’s PMD to 90% over 10 months. INTERVENTIONS: The 1st intervention was an email sent to all residents informing about the OEMR messaging system. The 2nd intervention was a discussion with all residents working on the pediatric floor about how to use the OEMR messaging system. The 3rd intervention included reminder notes about messaging the PMD on all computers on the pediatric floor. MEASURES: Every month, the message section was checked in the OEMR for each admitted clinic patient to see if a message was sent to the PMD. We measured the % of PMD’s notified of patient admissions at two-week intervals and made a run chart (shown above). RESULTS: Starting from a baseline of 20% OEMR messaging in July 2015, our next data point increased to 43% but dropped to 0 % by the 2nd week of September. We initiated our 1st intervention then and saw improvement to 46%, followed by a dip before increasing again to 88% in December, 2015. We then started our 2nd intervention, but we saw a drop to 38%. We made the 3rd intervention the 2nd week of January and then saw a gradual improvement to 100% before leveling off to 75% at the conclusion of the QI project. CONCLUSIONS AND NEXT STEPS: Our QI project highlighted that teamwork, identifying problems early and intervening consistently can bring progressive improvement in communication about patient care. A barrier was that there is a separate inpatient and outpatient EMR, requiring consistent prompting to use the messaging system. Making it part of the admission checklist may help with consistency of messaging in the future. 42. IMPROVING HOSPITAL COMMUNICATION THROUGH STANDARDIZATION OF PAGING PRACTICES Rachel M. Weigert, MD, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, Anna Schmitz, MD, Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, WI
e20
ABSTRACTS
ACADEMIC PEDIATRICS
Winner - APPD 2016 QI Project Award 43. WATCHER INITIATIVE DECREASES UNSAFE TRANSFERS TO A HIGHER LEVEL OF CARE Melanie M. Smith, DO, Maryanne M. Chumpia, MD, Lindsey A. Wargo, MD, Mark Bugnitz, MD, University of Tennessee, Memphis, TN
BACKGROUND: Paging is a primary mode of communication in hospitals, though it is asynchronous and often inconsistent. Children’s Hospital of Wisconsin (CHW) does not have a standardized paging format with variation in practice leading to staff dissatisfaction as well as roughly 6 reported patient care incidents per year resulting from pager related communication errors. AIM STATEMENT: Our Primary Aims were 1) create a standardized format designed to increase pages containing sender’s full name, call-back number, patient name, room number, and urgency wording to a goal of 90% for each element, and 2) improve provider ratings of the quality of paging communication with 80% of respondents rating paging satisfaction as excellent by January 2017. INTERVENTIONS: Interventions to date have included verbal announcements presented hospital-wide to residents and nursing staff, orientation material on paging etiquette, and posting of informational flyers were posted hospital between October and December 2015. MEASURES: Outcome Measures for this project include percent of pages containing each key element, rating of provider satisfaction with paging communication, and the frequency of patient safety events related to paging tracked over time. Process measures include ratings of timeliness and appropriateness of response to pages measured via survey, and frequency of pages including 5-6/6 critical elements. Balancing measures include measure of number of pages sent per day and paging satisfaction. RESULTS: Preliminary analysis revealed that respondents sent an average of 5-15 pages per day and rated paging communication as intermediate/good (3.3/5 point scale). There was an improvement in frequency of inclusion of 6/6 critical elements and inclusion of patient’s room number. Evaluation of other critical elements demonstrates stable or declining inclusion to date. CONCLUSIONS AND NEXT STEPS: After initial interventions aimed at improving the quality of paging communication in our hospital using a standardized format there are some early signs of improvement. Reaching the goal of widespread use of a standardized paging format will likely require multiple targeted interventions to reach all providers involved and achieve sustainable culture change. With further interventions and data collection, we hope to show standardized paging etiquette improves the clarity of communication and thereby both provider satisfaction and patient care.
BACKGROUND: Unrecognized clinical deterioration is a serious safety issue, and inability of care teams to promptly identify decompensating patients often leads to preventable undesirable outcomes. In an effort to reduce the number of poor clinical outcomes, we referenced an existing model at Cincinnati Children’s Hospital where huddles were used to identify “watchers” and prevent “unrecognized situation awareness failure events” (UNSAFE). We modified their system to fit our hospital’s floorbased inpatient setting. UNSAFE transfers include patients who required intubation, vasopressors, or >/¼ 3 fluid boluses either before or within one hour after transfer to a higher level of care. AIM STATEMENT: Our goal was to decrease the number of UNSAFE transfers from the targeted inpatient floor(s) to an ICU setting by 50% over a 6-month period. INTERVENTIONS: In May 2015, we asked residents and nurses to identify “watchers” based on defined criteria. This was reported in a daily safety brief. In July, we piloted twice daily huddles on an inpatient floor and have been implementing them on the remaining floors since that time. These huddles include a nursing patient care coordinator, supervising resident(s), and respiratory therapist. The huddles occur twice daily to communicate a plan for intervention and expected outcome within a designated time frame. This information is then disseminated to the bedside nurse and intern, who follow up on the outcome. MEASURES: We evaluated the number of UNSAFE transfers, as well as deaths on the floor, compared to the total number of transfers to an ICU setting. RESULTS: Prior to starting the daily safety brief in May, the percentage of UNSAFE transfers to a higher level of care was 14% over the previous 16 months. Our first intervention resulted in a 61% decrease in UNSAFE transfers. After our second