Quality Improvement Commons^™

Improving Pneumococcal Immunization Counseling In Children With Systemic Lupus Erythematous, Sarah Dettmann

Doctoral Dissertations & Projects

Background: Pediatric patients with systemic lupus erythematosus (SLE) face elevated risk for invasive pneumococcal disease, yet fewer than 10% are estimated to be current on pneumococcal vaccine (PCV) recommendations.

Local Problem: This quality improvement (QI) project aimed to develop and implement a standardized pneumococcal immunization screening and counseling process in a pediatric rheumatology clinic.

Method: Three consecutive PDSA cycles guided implemention across a nine-week intervention period using a pre-post quasi-experimental design.

Interventions: A multicomponent strategy was employed, including a PCV decision algorithm, EHR Smart Phrase, PCP referral template, and patient education brochure.

Results: Pre-implementation PCV counseling was documented …

The Home Visiting Referral Quality Improvement Initiative (Thrive) Change Package, Elizabeth Yakes Jimenez, Theresa Cruz, Rebecca Craig, Ivan De La Rosa

Population Health Research and Scholarship

Early childhood home visiting programs improve maternal and child health outcomes but remain underutilized. Healthcare providers are well-positioned to connect families to home visiting services; however, structural barriers in clinical settings limit consistent and effective referral practices. The Home Visiting Referral Quality Improvement Initiative (THRIVE) change package was developed to provide a starting point for addressing these challenges. The THRIVE change package outlines actionable improvement strategies to test, such as standardizing referral workflows, training clinical teams, and establishing relationships and feedback loops with home visiting programs. It offers a scalable approach to strengthening clinical–community linkages and improving family engagement with …

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

Implementation Of A Nurse Practitioner-Led Video Telehealth Program To Improve Triage For Pediatric Patients In An Ambulatory Intestinal Rehabilitation Center, Elizabeth Castle

Doctor of Nursing Practice Scholarly Projects

Background: Children with short bowel syndrome are medically complex, requiring specialized management and coordinated care to address acute triage issues between scheduled visits. Their risk for rapid decompensation and distance from specialty centers often necessitates telephone-based triage—a typically non-reimbursable method. At a leading Northeastern U.S. children’s hospital, the Intestinal Rehabilitation (IR) center manages high-risk telephone triage of these patients’ concerns using experienced nurse practitioners. The inability to directly visualize patients during telephone encounters, however, limits clinical assessment and decision-making, presenting challenges to efficient and safe care delivery. A systematic literature review indicated that telehealth can enhance parental confidence, improve clinician …

The Burden Of Care: Understanding Burnout Among Pediatric Healthcare Workers, Navya Khandavalli

Theses/Capstones/Creative Projects

Burnout among pediatric healthcare professionals is a growing concern that impacts both employee well-being and the overall quality of patient care. The aim of this study is to analyze the definition of burnout and how healthcare organizations can implore strategies to help improve the mental and physical well-being of their staff. Analysis was done through a survey administered to healthcare employees recruited from pediatric clinics, the neonatal ICU, pediatric research, and pediatric rehabilitation facilities. Findings from the methods found that burnout is often defined as prolonged occupational stress in an individual and are often characterized by symptoms of emotional exhaustion, …

Evaluating The Efficacy Of Discharge Education On Readmission Rates In Pediatric Patients With Chronic Conditions: A Scoping Review, Camden Shaw Bsn, Rn, Cpn, Ashely St. Julien Bsn, Rn, Claire Avant Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac, Chppn

Doctor of Nursing Practice Projects

Abstract Assignment

Purpose/Background

Children with multiple chronic health conditions account for a significant portion of hospital readmission and healthcare expenses. A scoping review was completed to analyze and summarize the available research regarding the effectiveness of discharge education on readmission rates and associated outcomes in children with chronic conditions. The following PICOT question was created: In pediatric patients with chronic disease, how does a discharge education bundle compared to no discharge education bundle affect readmission rates within 30 days of discharge?

Methods

A systematic approach was utilized for analysis to determine article eligibility. The initial search yielded 30 articles; however, …

Longitudinal Program Evaluation Of An Inter-Institutional Mentorship Network For Pediatric Rheumatology Using A Quality Improvement Framework, Kristen Hayward, Alexi Grom, Eyal Muscal, Peter A Nigrovic, Kelly A Rouster-Stevens, Kaveh Ardalan, Linda Hiraki, L Nandini Moorthy

Faculty, Staff and Students Publications

BACKGROUND: The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network.

METHODS: A mixed-methods approach centered on a …

The Impact Of Social Determinants Of Health On Adherence To Urinary Tract Infection Treatment: A Scoping Review, Barrett S. Patel, Ms, Bsn, Rn, Emily A. Gentry, Bsn, Rn, Sally Humphrey Dnp, Aprn, Cpnp-Pc, Bobby Bellflower Dnsc, Nnp-Bc, Faanp, Fnap

Doctor of Nursing Practice Projects

Purpose/Background

Urinary tract infections (UTIs) are a common diagnosis among children. Patients must fully comply with treatment regimens to reduce the risk of recurring UTIs and prevent long-term complications. This scoping review aims to evaluate the literature and examine the association between screening for social determinants of health (SDH) and adherence to UTI treatment.

Methods

A thorough literature search via PubMed, Cochrane Library, Elsevier Clinical Key, CINAHL, and JAMA was conducted with the following keywords: Pediatric UTI, Adherence to Treatment Plans, Social Determinants of Health, Social Needs Screening, and others. Ten articles were appraised for their evidence and quality. The …

A Guide To Pediatric Wellness Through Utilization Of Dragon Commands, Prasad Munusamy, Parisa Biazar, Jacob Trimble, Anthony Shadiack

South Atlantic Division GME Research Day 2024

No abstract provided.

Quality Improvement Initiative To Improve Time And Adherence To Revaccination After Hematopoietic Cell Transplantation: Implementation Of A Revaccination Clinic Within The Transplantation Program, Caitlin Elgarten, Anne Wohlschlaeger, Ellen Levy, Katharine Tadley, Lei Wang, Megan Atkinson, Houston Roberson, Timothy Olson, Nancy Bunin, Jennifer Heimall, Brian Fisher, Stephan Grupp, Jason Freedman

Faculty, Staff and Students Publications

Background:

Revaccination after hematopoietic cell transplantation (HCT) is critical to prevent morbidity and mortality from vaccine preventable illnesses. While earlier re-vaccination after HCT is desirable, they may be ineffective if deployed before partial reconstitution of adaptive immunity. Increasingly, personalized approaches to re-vaccination after HCT have replaced time-based protocols in order to minimize unvaccinated time and enhance vaccine effectiveness. Furthermore, for revaccination to be maximally beneficial, compliance with, and timely delivery of the complete revaccination schedule is imperative, but rare, and there is little data on strategies to optimize vaccine delivery.

Objectives:

The global aim of our quality improvement initiative was …

Seeing Is Believing: Implementation Of An Usgpiv Training Curriculum In Pediatric Medical Providers, Matthew Toma, Allyn Parker, Sunil Keshwah

South Atlantic Division GME Research Day 2023

No abstract provided.

Improving The Accuracy Of Interactive Voice Response (Ivr) Technology For Pediatric Experience Scores, Elizabeth Spaargaren Ms, Mph, Cpxp, Abigail Kozak Mba, Cpxp, Cara Herbener Cpxp, Barbara Lawlor Burke Ma, Cpxp

Patient Experience Journal

The increased use of interactive voice response (IVR) in assessing patient and family experience should be paired with evidence-based practices on how to obtain the most accurate information via this survey mode. We added a brief clarification sentence of the survey scale at the start of the IVR call to improve our experience data both qualitatively and quantitatively. Our setting was an urban pediatric hospital. We gathered lived experiences from our patients, families, and providers to understand and design a change to the IVR survey mode that would reduce survey inaccuracies. Outcome measures were assessed by baseline measurement and post-intervention …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Comparing Patient Experience Survey Scores Between Telehealth And In-Person Ambulatory Pediatric Subspecialty Visits, Sean T. Bomher, Matthew Wood, Elizabeth Uhlhorn, Sandro Marques, Lee Kwiatkowski, Natasa Tekic, Cameron D'Alpe, Natalie M. Pageler, Lane F. Donnelly

Patient Experience Journal

To determine the effect of encounter methods on patient experience, we evaluated patient experience survey data comparing scores between telehealth and in-person visits and pre-COVID-19 and COVID-19 time periods. Pediatric subspecialty visits were either in-person or via telehealth and received the same 16-question patient experience survey. Top box (5/5) scores were compared between in-person and telehealth visits for pre-COVID-19 and COVID-19 periods as well as between periods for in-person and telehealth visits. In addition, for both time periods and encounter methods, correlation analysis was performed to evaluate best correlation between likelihood to recommend practice and the 15 other survey questions. …

Incorporating Emergency Management Training Within School-Based Health Centers, Alicia Christian

Seton Hall University Dissertations and Theses (ETDs)

Background: Emergencies are situations that present without warning but require skilled individuals to provide aid to someone needing assistance. The pediatric primary care setting rarely experiences emergency-based care, which could lead to a lack of training in this area of expertise. As pediatric primary care extends to schools, there is also a need to ensure staff and providers have an annual emergency management training program. Project Aim: The current program aimed to determine the need to incorporate emergency management training in the school-based health center (SBHC) setting. Methods: This quality improvement project method was a pre-intervention with post-intervention design. The …

Sociodemographic Characteristics And Patient And Family Experience Survey Response Biases, Lauren N. Brinkman, Myra S. Saeed, Andrew F. Beck, Michael C. Ponti-Zins, Ndidi I. Unaka, Mary C. Burkhardt, Jareen Meinzen-Derr, Samuel P. Hanke

Patient Experience Journal

Enhancing Patient and Family Experience (PFE) is vital to the delivery of quality healthcare services. Sociodemographic differences affect health outcomes and experiences, but research is limited on biases in PFE survey methodology. We sought to assess survey participation rates across sociodemographic characteristics. This retrospective study analyzed a health system’s ambulatory PFE survey data, collected January 1 – July 31, 2019. Outcomes of interest were rates of survey response, completion, and comments. Predictors included respondent-reported race, ethnicity, language, and measure of social deprivation attached to a respondent’s home address. Addresses were geocoded to census tracts. The tract’s degree of socioeconomic deprivation …

Reach, Effectiveness, Adoption, And Maintenance Of Mobile Electronic Clinical Decision Support Tools Deployed As Part Of National Quality Improvement Projects, Ellen K. Kerns

Theses & Dissertations

Electronic clinical decision support (ECDS) tools are often developed within quality improvement (QI) projects to increase adherence with the latest clinical practice guidelines. However, the potential reach and maintenance of ECDS use beyond the time and location of their associated project are very limited. Deploying ECDS using a mobile app (mECDS) has shown the potential to be a viable method of overcoming these limitations. However, it is unclear what pattern the reach and adoption of such a tool might follow and what effect this use has on clinical practice. Our team developed an app which contained two different mECDS tools …

Effect Of An Electronic Order Set On Newborn Hepatitis B Immunization Rates, Daniel Pedersen, Angelina Rodriguez, Olu Oyesanmi, Heather Schramm, Michael King

HCA Healthcare Journal of Medicine

Objective

Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission …