- Email: [email protected]
18.0 Current Developments in Quality Improvement
CLINICAL PERSPECTIVES 18.0 — 18.3
Methods: A literature search on electronic media use and disruptive, impulsecontrol, and conduct disorders, and trauma- and stressor-related disorders was carried out on PubMed and PsycINFO. A literature search relating electronic media to the following features was performed: family conflict, developmental trauma, traumatic stress, and problems with authority, anger, and violence. The most important and relevant data and ideas are consolidated for the presentation, incorporating the author’s clinical experiences. Results: Children who have experienced trauma and those with behavior disorders tend to be heavy users of technology. Furthermore, children growing up in chaotic families and adverse communities often turn to electronics as a way to connect, self-sooth, explore identity, and learn. Yet for children who have already experienced harsh environments, exposure to violent and antisocial content seems to worsen anger, aggression, self-control, and defiance of authority. Reliving trauma through media can perpetuate symptoms. Furthermore, media-related problems often appear in treatment with this population because of their tendency to defy authority, reenact trauma, and seek stimulation. In this circumstance, evidence-based, familyfocused interventions, such as strengthening family bonds, reducing negative communications, shaping new behaviors, and rewarding positive changes, can be applied. Motivational and psychoeducational individual approaches seem to be most effective with these children and adolescents. Conclusions: Research confirms an overall negative effect of electronic media in traumatized populations and children with behavioral disorders, yet this is as much a symptom as a cause. Nonetheless, unhealthy relationships with electronic media can worsen these disorders. Clinicians treating children with disruptive behavior disorders and trauma-related disorders will need to assess for and treat problems related to the media and technologies.
COMP, CD, PTSD http://dx.doi.org/10.1016/j.jaac.2017.07.103
CLINICAL PERSPECTIVES 18 CURRENT DEVELOPMENTS IN QUALITY IMPROVEMENT Oscar Gary Bukstein, MD, MPH, Boston Children’s Hospital, [email protected] Objectives: Participants will recognize the basic elements and examples of the implementation of quality improvement in clinical services for child and adolescent psychiatry. Methods: Through five didactic presentations based on literature review and presenter experience, presenters will provide an overview of quality improvement and a variety of quality improvement projects and examples. Results: The presenters will provide information on the following: 1) definition, dimensions, and process of quality improvement efforts; 2) potential solutions to problems in quality dimensions on inpatient units; 3) the value of measurement-based practice for outcomes in child/adolescent psychiatry practice; 4) quality improvement problem-solving process in dealing with the issue of boarders in a children’s hospital; and 5) the importance of clinical practice guidelines toward establishing quality measures and clinical outcomes. Conclusions: Although mental health clinicians need to be concerned with improved clinical outcomes of specific patients and their families, improved outcomes are often the result of systemic changes, good response to problems, and other domains of quality improvement.
ADMIN, QA Sponsored by AACAP's Quality Issues Committee http://dx.doi.org/10.1016/j.jaac.2017.07.105
18.1 UNDERSTANDING QUALITY IMPROVEMENT Oscar Gary Bukstein, MD, MPH, Boston Children’s Hospital, [email protected] Objectives: In this session, participants will learn about the following: 1) that inpatient psychiatry is a high-risk area for patients and healthcare providers; 2) development of highly effective healthcare teams is required to deliver
S26
www.jaacap.org
reliably safe and high-quality outcomes for patients, families, and staff; 3) integrating quality improvement principles provides a framework to enhance clinical programs and improve clinical team performance; and 4) specific quality improvement efforts that decrease rates of patient and staff injury. Methods: Literature review and case examples will be used. Basic principles of quality improvement science and its role in healthcare will be introduced. Successful efforts to improve patient safety and staff injury across a large inpatient program will be discussed. Results: Participants will be able to 1) understand the dangers associated with inpatient psychiatric care for patients and staff and the need for systematic approach to improve the outcomes for patients and caregivers; 2) understand the usefulness of quality improvement principles in shaping the development and functioning of multidisciplinary care teams; 3) be able to identify strategies to improve patient safety in the acute care setting; and 4) identify methods to engage staff in programs that decrease caregiver injury. Conclusions: The application of quality improvement principles allows the clinician to more effectively manage the complex system of the inpatient setting and put in place effective programs that improve safety for patients and caregivers.
ADMIN, MDM, QA http://dx.doi.org/10.1016/j.jaac.2017.07.106
18.2 USING QUALITY IMPROVEMENT TO ENHANCE SAFETY ON INPATIENT UNITS Michael T. Sorter, MD, Cincinnati Children’s Hospital Medical Center, [email protected] Objectives: Participants will learn about the following: 1) that inpatient psychiatry is a high-risk area for patients and healthcare providers; 2) that development of highly effective healthcare teams are required to deliver reliably safe and high-quality outcomes for patients, families, and staff; 3) that integrating quality improvement principles provides a framework to enhance clinical programs and improve clinical team performance; and 4) that specific quality improvement efforts decrease rates of patient and staff injury. Methods: Literature review and case examples will be presented. Basic principles of quality improvement science and its role in healthcare will be introduced. Successful efforts to improve patient safety and staff injury across a large inpatient program will be discussed. Results: Participants will 1) understand the dangers associated with inpatient psychiatric care for patients and staff and the need for systematic approach to improve the outcomes for patients and caregivers; 2) understand the usefulness of quality improvement principles in shaping the development and functioning of multidisciplinary care teams; 3) be able to identify strategies to improve patient safety in the acute care setting; and 4) identify methods to engage staff in programs that decrease caregiver injury. Conclusions: The application of quality improvement principles allows the clinician to more effectively manage the complex system of the inpatient setting and put into place effective programs that improve safety for patients and caregivers.
AGG, ICP, QA http://dx.doi.org/10.1016/j.jaac.2017.07.107
18.3 MEASURING OUTCOMES IN AMBULATORY PSYCHIATRY Rajeev Krishna, MD, PhD, MBA, Nationwide Children’s Hospital, [email protected] Objectives: The objective of this presentation is to demonstrate how quality improvement techniques and automated assessment systems were used in a large ambulatory psychiatry clinic to build the infrastructure for outcomebased care. Methods: The Institute for Healthcare Improvement (IHI) quality improvement methodology was used to identify barriers to implementation of outcomebased care. A series of interventions using Plan-Do-Study-Act (PDSA) cycles were used to deploy an automated infrastructure for collecting and scoring
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Methods: A literature search on electronic media use and disruptive, impulsecontrol, and conduct disorders, and trauma- and stressor-related disorders was carried out on PubMed and PsycINFO. A literature search relating electronic media to the following features was performed: family conflict, developmental trauma, traumatic stress, and problems with authority, anger, and violence. The most important and relevant data and ideas are consolidated for the presentation, incorporating the author’s clinical experiences. Results: Children who have experienced trauma and those with behavior disorders tend to be heavy users of technology. Furthermore, children growing up in chaotic families and adverse communities often turn to electronics as a way to connect, self-sooth, explore identity, and learn. Yet for children who have already experienced harsh environments, exposure to violent and antisocial content seems to worsen anger, aggression, self-control, and defiance of authority. Reliving trauma through media can perpetuate symptoms. Furthermore, media-related problems often appear in treatment with this population because of their tendency to defy authority, reenact trauma, and seek stimulation. In this circumstance, evidence-based, familyfocused interventions, such as strengthening family bonds, reducing negative communications, shaping new behaviors, and rewarding positive changes, can be applied. Motivational and psychoeducational individual approaches seem to be most effective with these children and adolescents. Conclusions: Research confirms an overall negative effect of electronic media in traumatized populations and children with behavioral disorders, yet this is as much a symptom as a cause. Nonetheless, unhealthy relationships with electronic media can worsen these disorders. Clinicians treating children with disruptive behavior disorders and trauma-related disorders will need to assess for and treat problems related to the media and technologies.
COMP, CD, PTSD http://dx.doi.org/10.1016/j.jaac.2017.07.103
CLINICAL PERSPECTIVES 18 CURRENT DEVELOPMENTS IN QUALITY IMPROVEMENT Oscar Gary Bukstein, MD, MPH, Boston Children’s Hospital, [email protected] Objectives: Participants will recognize the basic elements and examples of the implementation of quality improvement in clinical services for child and adolescent psychiatry. Methods: Through five didactic presentations based on literature review and presenter experience, presenters will provide an overview of quality improvement and a variety of quality improvement projects and examples. Results: The presenters will provide information on the following: 1) definition, dimensions, and process of quality improvement efforts; 2) potential solutions to problems in quality dimensions on inpatient units; 3) the value of measurement-based practice for outcomes in child/adolescent psychiatry practice; 4) quality improvement problem-solving process in dealing with the issue of boarders in a children’s hospital; and 5) the importance of clinical practice guidelines toward establishing quality measures and clinical outcomes. Conclusions: Although mental health clinicians need to be concerned with improved clinical outcomes of specific patients and their families, improved outcomes are often the result of systemic changes, good response to problems, and other domains of quality improvement.
ADMIN, QA Sponsored by AACAP's Quality Issues Committee http://dx.doi.org/10.1016/j.jaac.2017.07.105
18.1 UNDERSTANDING QUALITY IMPROVEMENT Oscar Gary Bukstein, MD, MPH, Boston Children’s Hospital, [email protected] Objectives: In this session, participants will learn about the following: 1) that inpatient psychiatry is a high-risk area for patients and healthcare providers; 2) development of highly effective healthcare teams is required to deliver
S26
www.jaacap.org
reliably safe and high-quality outcomes for patients, families, and staff; 3) integrating quality improvement principles provides a framework to enhance clinical programs and improve clinical team performance; and 4) specific quality improvement efforts that decrease rates of patient and staff injury. Methods: Literature review and case examples will be used. Basic principles of quality improvement science and its role in healthcare will be introduced. Successful efforts to improve patient safety and staff injury across a large inpatient program will be discussed. Results: Participants will be able to 1) understand the dangers associated with inpatient psychiatric care for patients and staff and the need for systematic approach to improve the outcomes for patients and caregivers; 2) understand the usefulness of quality improvement principles in shaping the development and functioning of multidisciplinary care teams; 3) be able to identify strategies to improve patient safety in the acute care setting; and 4) identify methods to engage staff in programs that decrease caregiver injury. Conclusions: The application of quality improvement principles allows the clinician to more effectively manage the complex system of the inpatient setting and put in place effective programs that improve safety for patients and caregivers.
ADMIN, MDM, QA http://dx.doi.org/10.1016/j.jaac.2017.07.106
18.2 USING QUALITY IMPROVEMENT TO ENHANCE SAFETY ON INPATIENT UNITS Michael T. Sorter, MD, Cincinnati Children’s Hospital Medical Center, [email protected] Objectives: Participants will learn about the following: 1) that inpatient psychiatry is a high-risk area for patients and healthcare providers; 2) that development of highly effective healthcare teams are required to deliver reliably safe and high-quality outcomes for patients, families, and staff; 3) that integrating quality improvement principles provides a framework to enhance clinical programs and improve clinical team performance; and 4) that specific quality improvement efforts decrease rates of patient and staff injury. Methods: Literature review and case examples will be presented. Basic principles of quality improvement science and its role in healthcare will be introduced. Successful efforts to improve patient safety and staff injury across a large inpatient program will be discussed. Results: Participants will 1) understand the dangers associated with inpatient psychiatric care for patients and staff and the need for systematic approach to improve the outcomes for patients and caregivers; 2) understand the usefulness of quality improvement principles in shaping the development and functioning of multidisciplinary care teams; 3) be able to identify strategies to improve patient safety in the acute care setting; and 4) identify methods to engage staff in programs that decrease caregiver injury. Conclusions: The application of quality improvement principles allows the clinician to more effectively manage the complex system of the inpatient setting and put into place effective programs that improve safety for patients and caregivers.
AGG, ICP, QA http://dx.doi.org/10.1016/j.jaac.2017.07.107
18.3 MEASURING OUTCOMES IN AMBULATORY PSYCHIATRY Rajeev Krishna, MD, PhD, MBA, Nationwide Children’s Hospital, [email protected] Objectives: The objective of this presentation is to demonstrate how quality improvement techniques and automated assessment systems were used in a large ambulatory psychiatry clinic to build the infrastructure for outcomebased care. Methods: The Institute for Healthcare Improvement (IHI) quality improvement methodology was used to identify barriers to implementation of outcomebased care. A series of interventions using Plan-Do-Study-Act (PDSA) cycles were used to deploy an automated infrastructure for collecting and scoring
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017