PHM Quality Improvement Collaboratives An Update

1. PHM Quality Improvement CollaborativesAn Update

2. Collaborative #1Co Chairs: Shannon Phillips, MD, MPHPaul Hain, MD • Specific AIM: • We will reduce the percent of patient ID band errors at hospitals in this collaborative by 50% by September 1, 2010.

3. Collaborative Colleagues Consulting • Monroe Carell Jr. Children's Hospital at Vanderbilt TN • Paul Hain, MD Collaborative • Cleveland Clinic Children’s Hospital OH • Shannon Phillips, MD, MPH • Meredith Lahl, RN, MSN, CNS  • Denver Children’s Hospital CO • Dan Hyman, MD • Mariel Laire • New York Hospital Queens • Laurie Gordon, MD • Our Lady of the Lake Regional Medical Center LA • Steve Narang, MD • Tracie Major, APRN, CNS, CPN • James Whitcomb Riley Children’s Hospital IN • Michele Saysana, MD • Scottsdale Healthcare Hospitals AZ • John Pope, MD • MorganStanley Children’s Hospital of NY Presbyterian • AnuSubramony, MD • Presbyterian Intercommunity Hospital CA • Jeff Gill, MD

4. Results 18% 6%

5. Change Concepts • Raise awareness of safety risk for • Staff • Parents/Patients • Shared educational materials • Kinder, gentler ID bands

6. Collaborative #2Co Chairs:Mark Shen, MDJulia Shelburne,MD • Specific Aim: • Over the next 6 months, we will lead a quality improvement collaborative and achieve measureable improvement in the frequency AND timeliness of communication of patient information to the PCPs at discharge with the Goal of 90% of hospitalist discharges at each participating hospital will have documentation of communication with a PCP within 2 calendar days of actual discharge.

7. Participants • Lora Bergert: Kapi`olani Medical Center, Honolulu • Michael Bryant: USC Keck School of Medicine • David Cooperberg: St. Christopher’s, Philadelphia • Dan Coughlin: Hasbro Children’s, Providence • Leah Mallory: Barbara Bush Children’s Hospital at Maine Medical Center ,Portland • Beth Robbins:Anne Arundel Medical Center, Annapolis • Julia Shelburne: UT-Houston Medical School/Children’s Memorial Hermann Hospital • Mark Shen and Don Williams: Dell Children’s Medical Center, Austin • Ann Vanden Belt: St. Joseph Mercy Hospital, Ypsilanti, MI • Joyce Yang, Dan Hershey, and Erin Stucky: Rady Children’s Hospital, San Diego

8. Results Percent of discharges with documented communication with PCP within 2 calendar days of discharge, by month

9. Change Package • Obtain support of hospital leadership • Gather accurate contact information • Automate the process using IT solutions • Provide targeted and timely feedback to physicians • Create incentives for attending physicians

10. Collaborative #3Co Chairs: Matt Garber, MDBeth Robbins, MD • Specific AIM: • Reduce the use of inhaled short-acting bronchodilators in children hospitalized with bronchiolitis • To reduce the number of bronchiolitis patients treated with any bronchodilator medication by 20% from that institution’s baseline or to <=30% • To reduce the average total number of treatments per patient by 50% from that institution’s baseline

11. Participants • Elizabeth L. Robbins, Anne Arundel Medical Center • Jeanann P. Pardue MD, Director of CPG Inpatient Service East TN Children's Hospital • Michele Lossius, MD, FAAP Assistant Professor, UF-COM • Eric Balighian, Pediatric Hospitalist, St. Agnes Hospital • John A Pope MD, MPH, Physician Director, Pediatric Services, Scottsdale Healthcare Hospitals • Matthew Garber, MD,FAAP, FHM, Assistant Professor USC-SOM, Director Pediatric Hospitalists

12. % Bronchodilator Use: Preliminary DataAverage of 25% decrease

13. % of Bronchodilator doses/pt: Prel DataAverage of 47% Decrease

14. Change package • A Respiratory Therapists Driven Protocol • Communication at every level – nurse, RT, PCP, ED attendings, other hospitalists, learners - is needed to address cultural barriers • New partnerships with RT, RN, IT, CQI, and administration are also needed to address technical barriers

15. Next Steps for PHM QI Collaboratives.. • We have “tested the concept” • PHM Physicians Can Collaborate to Improve Care • Next Challenge • Sustaining and Disseminating • Finding a “home” for funding and infrastructure • MOC for Pediatric Hospitalists ?