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Pediatric Update

October 2013

Making quality and safety a top priority

grossman

A Q&A with YNHCH Quality and Safety Officer Matthew Grossman, MD

Matthew Grossman, MD, understands that improving quality and safety, and doing it in a transparent way is one of the most important issues in health care today. As the quality and safety officer at Yale-New Haven Children's Hospital, Dr. Grossman oversees a team of quality leaders dedicated to transforming the way health care is delivered and to implementing quality improvements to advance patient safety, outcomes and experiences. Grossman, an assistant professor of pediatrics at Yale School of Medicine, also serves as associate director of Yale-New Haven Hospital's Pediatric Residency Program, and medical director of Yale-New Haven Children's Hospital Short-Stay Unit. He recently answered questions about his role and quality and safety initiatives at YNHCH.

Q: What exactly does quality and safety encompass at YNHCH?

MG: We look at six major factors: safety, timeliness, efficiency, effectiveness, equitability and patient-centered care. The first is safety. Are we avoiding hospital-acquired harm to patients? It's more than "do no harm." It's making sure the experience is safe and that we are preventing anything we can that would harm the patient. Timely care means that we avoid unnecessary waits for appointments, tests, diagnoses and other services. Efficiency and effectiveness cover appropriate management of services, avoiding unnecessary tests and implementing ideas from our staff on how to improve quality and safety. Providing equitable care means that every patient receives the same quality of care regardless of race, gender, religion, income or other factors. Finally, patient-centered care guarantees that we include the patients' families in all aspects of the decision-making process about their care.

Q: How are you engaging staff in the quality and safety process?

MG: A nurse and a physician are quality leaders on each unit. They run monthly meetings. They look at both important hospital-wide metrics, as well as the unit-specific metrics that they've developed. They report every six months to our Children's Hospital Quality and Safety Committee on things that people thought were either unsafe events, near hits, or safety events and how they responded and the projects they were working on. They're thriving, and the quality of the projects is really improving.

We've also engaged the resident population to think about, "How is the next patient going to be harmed? How can we make this process better?" The number of ideas and projects that emerged in just the first six months we worked with them has been quite stunning.

Q: What are you measuring in terms of quality and safety?

MG: Our major measures are mostly looking at hospital-acquired conditions, areas where we feel there is preventable harm. For example, we look at central line-associated bloodstream infections, catheter-associated urinary tract infections and adverse drug events. We are either measuring those or trying to develop ways to measure them better. When an individual unit is identifying a problem, we have them figure out what their ideal state is and how to get there, and how they're going to know that the change they've made is an improvement.

Our overall scorecard that we look at in the quality group is a "serious safety event rate." How often are we having serious safety events that are a deviation from our normal approach or practice that causes harm to a patient? When we have one of these events, we do what we call our root-cause analysis, looking at what the system factors were that led to this and how can we change them.

Q: What are some of the quality and safety initiatives that have been implemented at YNHCH?

MG: One of our major initiatives is a patient-centered approach called PRECEPT: Pain Reduction, Every Child, Every Possible Time. This is our new approach to handling IV sticks and blood draws in pediatric patients, which is often a traumatic experience. Our goal is to improve the patient and family experience and minimize patient pain and anxiety. We now have easier access to topical pain medications and we're using our Child Life program, as well as some technological advances with a vein illumination device. We also developed essentially IV experts on each unit, who are always available to take the more difficult cases.

Patient satisfaction reports found that we significantly improved how the experience is explained to families, the feeling of the skill of the person starting the IV and the concern for comfort. In concern for comfort, we were in the 27th percentile and grew to the 87th percentile. How well a child's pain is controlled went from the 9th percentile to the 81st percentile.

In addition, it's now our hospital policy to do family-centered rounds, where all of our decisions are made in front of the families, which is really well received. We've seen our overall patient satisfaction scores rise there too.

Another initiative focuses on serious safety events and hospital-acquired conditions. We joined a collaborative with 80 other hospitals that also evaluate this information. As a result, we will be able to both teach and learn with this group to eliminate or minimize harm in 11 key areas. For example, our neonatal ICU experienced dramatic results in eliminating central line bloodstream infections, becoming a hospital and national leader in that effort. Finally, we've joined the Pediatric Health Information System, which takes all of our billing and diagnostic data, and compares us to 42 other hospitals. We are able to compare our length of stays, our utilization of certain medications with certain diseases, and what our costs are to help make our care more effective.

Pediatric Emergency Medicine at YNHCH

Meet the new team members:
Paul Aronson, MD Beth Emerson, MD
Katherine Hesse, MD, Kristin M. Kim, MD, PhD, F.A.A.P
Bonnie MacKenzie, MD Lawrence Siew, MD
Gunjan Tiyyagura, MD    

 

santucci

A message from Karen A. Santucci, MD, chief of pediatric emergency medicine, YNHCH and professor of pediatrics (emergency medicine), Yale School of Medicine.

 

I am thrilled to give you an update regarding Pediatric Emergency Medicine at YNHCH. During the past two years we have recruited three new faculty members: Paul Aronson, MD, who joined our team from The Children's Hospital of Philadelphia; and Beth Emerson, MD, and Gunjan Tiyyagura (Kamdar), MD, recent graduates of our fellowship program.

In addition,Katherine Hesse, MD, Lawrence Siew, MD, also a Yale Pediatric Emergency Medicine alumnus, Bonnie MacKenzie, MD, and Kristin Kim, MD, are working with us on a part-time basis as part of our new and innovative collaborative agreement with Lawrence & Memorial Hospital.

Rounding out our team are six subspecialty fellows and seven advanced-level practitioners, training and practicing alongside our crew of 13 faculty members working in the Pediatric Emergency Department by day (and night), advancing the field of Pediatric Emergency Medicine on the national and international front.

The Pediatric Emergency Medicine team is heavily engaged in quality and safety, emergency preparedness, simulation, disaster preparedness, informatics, ultrasound, end-tidal CO2 detection, healthcare disparities, abuse/neglect, medical education, international health, behavioral health, Pediatric Advanced Life Support (PALS), qualitative research, clinical forensics and advancing the care of the trauma patient.

Wall of Hope

wall of hopeThe hallways of the Neonatal Intensive Care Unit (NICU) are graced with framed photographs of former patients, today between the ages of 8 months and 11 years, accompanied by plaques that tell an inspiring then-and-now story about each child. The permanent Wall of Hope display was developed over two years by the NICU Family Advisory Council, which enlisted the volunteered talents of New Haven photographer Jacklyn Greenberg and Westport independent curator Camilla Cook. The Wall of Hope is the project of members of the Family Advisory Council, which was formed in 2010, to come up with ways of helping families and patients. Staff members, administrators and parents all work together on the council to improve parents' experiences.

In front of their family photo in the front row are, from left, Hollis and triplet siblings Quinn, Sadie and Cashlyn Cunneen, born on March 9, 2007 at 31 weeks. Behind them are parents Cheryl and John Cunneen.

Germain named to associate chief post at YNHCH

Gregory S. Germain, MD, is the new Associate Chief of Children’s Services for the Department of Pediatrics and Yale-New Haven Children’s Hospital.

A member of Pediatric and Medical Associates in New Haven and Cheshire, Dr. Germain has attended Yale Pediatric Endocrine Clinic for more than 18 years.

He received his undergraduate degree from Fairfield University and medical degree from University of Connecticut, and served his residency in pediatrics at Yale-New Haven Children’s Hospital. Dr. Germain is a board member of New Haven Community Medical Group and a past president of the New Haven Pediatric Society. He is widely published on child health care and guidance for parents.

Dr. Germain replaces Joseph Zelson, MD, whose contributions will be celebrated this fall.

Kavita Dhodapkar, MD, recipient of $250,000 research grant

Dhodapkar

Kavita Dhodapkar, MD, is the recipient of the Hyundai Hope on Wheels Award research grant, “Developing Novel Approaches to Harness Immunity to Pediatric Brain Tumors.” Hyundai Hope On Wheels® and New Haven-area Hyundai dealers have awarded Yale School of Medicine (YSM) with a $250,000 Hyundai Hope Grant for pediatric cancer research. The grant funds will support the work of Dr. Kavita Dhodapkar, an attending pediatric hematologist-oncologist at YNHCH who is focused on developing personalized vaccines for the treatment of pediatric brain tumors. YSM is one of 41 recipients of Hope On Wheels’ 2013 Hyundai Hope Grants and has received $600,000 from Hope on Wheels since 2011.

Upcoming events

 

Liver Disease and Transplantation

in Children and Adults: Update 2013

7:30 a.m. to 4 p.m. Friday, Nov. 15
Waters Edge Conference Center
1525 Boston Post Road
Westbrook, CT 06498
For more information email farrah.nettleton@yale.edu


Second Annual Pediatric Trauma Symposium

4-8 p.m. Thursday, Dec. 12
Park Street Auditorium
55 Park St.
New Haven, CT 06511

For more information, call (203) 688-1498 or email linda.roney@ynhh.org.

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