- Email: [email protected]
QI Project: Bullying
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ABSTRACTS
of mock rounds and of the physical space, two sets of slides on how to pre-round and order parenteral nutrition, and a document highlighting common NICU terms and equations. This orientation bundle was introduced to the 2012-13 interns prior to their first NICU rotation. We then surveyed each intern as they completed their initial NICU rotation (Study). Interns rated the effectiveness of the new orientation materials, their familiarity with specific tasks and expectations, and their overall satisfaction with orientation. Statistical analysis was performed within and between groups using the Chi-square test. RESULTS: The survey response rate consisted of 60% (9/15) of interns in 2011-12 and 64% (9/14) of interns in 2012-13. Results reveal a trend towards improved overall satisfaction with orientation (P ¼ 0.056), with 7/9 of 2012-13 interns responding “mostly satisfied” as opposed to 7/9 of 2011-12 interns responding “not at all”, “slightly” or “neutral”. There was a significant improvement in understanding specific terminology and calculations (P ¼ 0.015) and an overall trend toward improvement in presenting patients, placing orders, understanding roles on rounds and knowing the physical space. CONCLUSION: With the development and implementation of a NICU peer-to-peer orientation bundle, interns reported greater overall satisfaction with their orientation experience and improved familiarity with specific tasks and expectations. Future plans to continue improving the orientation process (Act) may lead to better intern performance within the rotation. The next cycle will examine NICU leadership perception of improvement in intern performance and include plans for an intensive shadowing experience prior to the rotation.
ACADEMIC PEDIATRICS addressed bullying (14%) CYCLE TWO: DOCUMENTATION Goal: Prompt providers to screen at each visit dEpic dropdown question in the progress notes for all children aged 6-18 to ask if Bullying screen positive or negative dAdded to WCC 6-8 year old, WCC 9-11 year old, and adolescent templates. Development/Behavior plan section for all WCC visits for patients between 6 and 18 years old. CHART REVIEW d20 charts reviewed during December d18/20 addressed bullying (90%) CYCLE THREE:PARENT RESOURCE SHEET developed CYCLE FOUR:CREATE AND DISSEMINATE A CLINICAL PRACTICE ALGORITHM A work-flow model was instituted for all positive assessments. Positive bullying assessment a Mental Health Screen + Education - assess safety: If concern for safety or need for Mental Health Referral - SW consultation + Education: Summary email with suggested screening questions and clinical algorithm sent to all residents. CHART REVIEW : 20 charts reviewed during April. 16/20 addressed bullying (80%)2 positive (100% education provided). 16/20 addressed mental health (80%)1 positive (100% education provided and mental health referral). CONCLUSIONS: By increasing resident awareness and implementing a standardized process by which we screen for bullying, we observed a substantial and sustained increase in the percentage of well visits where bullying was addressed. For those patients who screened positive, educational materials were provided and the need for mental health referral was identified.
23. QI PROJECT: BULLYING Jennifer Dipace, MD, Melanie Wilson-Taylor, MD, Jennie Ono, MD, Weill Cornell Medical College/NYPHCornell, Alexis Feuer, MD, NYPH-Cornell, NY, NY BACKGROUND: The 2008-2009 School Crime Supplement indicates that, nationwide, 28% of students in grades 6-12 experienced bullying . Children and adolescents bullied have a higher incidence of anxiety, depression and psychiatric/psychosocial impairment. AIM STATEMENT: By June of 2012, 90% of patients ages 6-15 will have an annual bullying screen. Those patients with a positive bullying screen will have a mental health screening. Process Measures 95% patients with positive assessment will undergo mental health screen. 95% patients with positive assessment will receive parental/patient education. 95% patients with positive assessment will be referred to social work as needed. Tool Used: PDSA cycle used based on prior experience, ability to handoff project between residents, and iterative nature of project. PARTICIPANTS: 12 senior residents at NYPH-Weill Cornell who had continuity clinic at the Helmsley Tower, 5 general pediatrics practice and their mentors. Residents chose project topic and devised, planned, implemented and evaluated each step. The project was then presented at year’s end to the department with 4 other QI projects. CYCLE ONE: IDENTIFYING RESOURCES: multiple on line resources, telephone referral services and other resources were identified by the residents. PROVIDER EDUCATION: Reminders to RGP resident physicians to discuss bullying during well child visits. Realization of lack of validated screening tool for bullying. Compilation of screening questions from AAP and other sources proposed to aid screening while maintaining resident autonomy. BASELINE DATA COLLECTION: 14 charts reviewed during August 2/14
24. FORMAL RAPID RESPONSE EDUCATION FOR HOUSESTAFF INCREASES AWARENESS AND UTILIZATION: A RESIDENT LED QUALITY IMPROVEMENT INITIATIVE Elizabeth B. Morey, MD, Karen L. Bauer, MD, Audrey E. Hall, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, Raymond R. Balise, PhD, Stanford University, Stanford, CA, Kit Leong, RHIT, CPHQ, Lynda Knight, RN, MSN, CCRN, CPN, Lauren Destino, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA BACKGROUND: The use of RR (Rapid Response) teams in hospitals began in response to the Institute for Healthcare Improvements (IHI) 100,000 Lives Campaign. Subsequently, Sharek et al. demonstrated a reduction in codes outside the ICU by 71% and mortality by 18% in the two years following RR team implementation at Lucile Packard Childrens Hospital (LPCH). However, use of RRs may decline without continued
ABSTRACTS
of mock rounds and of the physical space, two sets of slides on how to pre-round and order parenteral nutrition, and a document highlighting common NICU terms and equations. This orientation bundle was introduced to the 2012-13 interns prior to their first NICU rotation. We then surveyed each intern as they completed their initial NICU rotation (Study). Interns rated the effectiveness of the new orientation materials, their familiarity with specific tasks and expectations, and their overall satisfaction with orientation. Statistical analysis was performed within and between groups using the Chi-square test. RESULTS: The survey response rate consisted of 60% (9/15) of interns in 2011-12 and 64% (9/14) of interns in 2012-13. Results reveal a trend towards improved overall satisfaction with orientation (P ¼ 0.056), with 7/9 of 2012-13 interns responding “mostly satisfied” as opposed to 7/9 of 2011-12 interns responding “not at all”, “slightly” or “neutral”. There was a significant improvement in understanding specific terminology and calculations (P ¼ 0.015) and an overall trend toward improvement in presenting patients, placing orders, understanding roles on rounds and knowing the physical space. CONCLUSION: With the development and implementation of a NICU peer-to-peer orientation bundle, interns reported greater overall satisfaction with their orientation experience and improved familiarity with specific tasks and expectations. Future plans to continue improving the orientation process (Act) may lead to better intern performance within the rotation. The next cycle will examine NICU leadership perception of improvement in intern performance and include plans for an intensive shadowing experience prior to the rotation.
ACADEMIC PEDIATRICS addressed bullying (14%) CYCLE TWO: DOCUMENTATION Goal: Prompt providers to screen at each visit dEpic dropdown question in the progress notes for all children aged 6-18 to ask if Bullying screen positive or negative dAdded to WCC 6-8 year old, WCC 9-11 year old, and adolescent templates. Development/Behavior plan section for all WCC visits for patients between 6 and 18 years old. CHART REVIEW d20 charts reviewed during December d18/20 addressed bullying (90%) CYCLE THREE:PARENT RESOURCE SHEET developed CYCLE FOUR:CREATE AND DISSEMINATE A CLINICAL PRACTICE ALGORITHM A work-flow model was instituted for all positive assessments. Positive bullying assessment a Mental Health Screen + Education - assess safety: If concern for safety or need for Mental Health Referral - SW consultation + Education: Summary email with suggested screening questions and clinical algorithm sent to all residents. CHART REVIEW : 20 charts reviewed during April. 16/20 addressed bullying (80%)2 positive (100% education provided). 16/20 addressed mental health (80%)1 positive (100% education provided and mental health referral). CONCLUSIONS: By increasing resident awareness and implementing a standardized process by which we screen for bullying, we observed a substantial and sustained increase in the percentage of well visits where bullying was addressed. For those patients who screened positive, educational materials were provided and the need for mental health referral was identified.
23. QI PROJECT: BULLYING Jennifer Dipace, MD, Melanie Wilson-Taylor, MD, Jennie Ono, MD, Weill Cornell Medical College/NYPHCornell, Alexis Feuer, MD, NYPH-Cornell, NY, NY BACKGROUND: The 2008-2009 School Crime Supplement indicates that, nationwide, 28% of students in grades 6-12 experienced bullying . Children and adolescents bullied have a higher incidence of anxiety, depression and psychiatric/psychosocial impairment. AIM STATEMENT: By June of 2012, 90% of patients ages 6-15 will have an annual bullying screen. Those patients with a positive bullying screen will have a mental health screening. Process Measures 95% patients with positive assessment will undergo mental health screen. 95% patients with positive assessment will receive parental/patient education. 95% patients with positive assessment will be referred to social work as needed. Tool Used: PDSA cycle used based on prior experience, ability to handoff project between residents, and iterative nature of project. PARTICIPANTS: 12 senior residents at NYPH-Weill Cornell who had continuity clinic at the Helmsley Tower, 5 general pediatrics practice and their mentors. Residents chose project topic and devised, planned, implemented and evaluated each step. The project was then presented at year’s end to the department with 4 other QI projects. CYCLE ONE: IDENTIFYING RESOURCES: multiple on line resources, telephone referral services and other resources were identified by the residents. PROVIDER EDUCATION: Reminders to RGP resident physicians to discuss bullying during well child visits. Realization of lack of validated screening tool for bullying. Compilation of screening questions from AAP and other sources proposed to aid screening while maintaining resident autonomy. BASELINE DATA COLLECTION: 14 charts reviewed during August 2/14
24. FORMAL RAPID RESPONSE EDUCATION FOR HOUSESTAFF INCREASES AWARENESS AND UTILIZATION: A RESIDENT LED QUALITY IMPROVEMENT INITIATIVE Elizabeth B. Morey, MD, Karen L. Bauer, MD, Audrey E. Hall, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, Raymond R. Balise, PhD, Stanford University, Stanford, CA, Kit Leong, RHIT, CPHQ, Lynda Knight, RN, MSN, CCRN, CPN, Lauren Destino, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA BACKGROUND: The use of RR (Rapid Response) teams in hospitals began in response to the Institute for Healthcare Improvements (IHI) 100,000 Lives Campaign. Subsequently, Sharek et al. demonstrated a reduction in codes outside the ICU by 71% and mortality by 18% in the two years following RR team implementation at Lucile Packard Childrens Hospital (LPCH). However, use of RRs may decline without continued