Alisa Khan, MD, is a pediatric hospitalist and health services research fellow at Boston Children’s Hospital. She and Christopher Landrigan, MD, MPH, research director of the Boston Children’s Hospital Inpatient Pediatrics Service, recently received a Community/Patient Empowerment Award at the National Pediatric Innovation Summit sponsored by the hospital.
A nightly family signout not only helps families of hospitalized children sleep better, but also empowers them to play an active role in patient safety.
Miscommunications are a root cause of more than 70 percent of sentinel events, the most serious preventable adverse events in hospitals, according to data from the Joint Commission and the Department of Defense. As Vector reported yesterday, a bundle of interventions focused on improving patient “handoffs” during clinician shift changes, piloted at Boston Children’s Hospital, resulted in a 46 percent reduction in medical errors and a 54 percent reduction in preventable adverse events. What’s now known as I-PASS is now being implemented at 10 children’s hospitals across the U.S.
While I-PASS has greatly improved patient safety and communication between medical providers, it does not currently involve the family. Yet families play a pivotal safety role, advocating for their children and monitoring their progress through acute illness. Full story »
Medical errors are a leading cause of death and injury in America, and an estimated 80 percent of serious medical errors involve some form of miscommunication, particularly during the transfer of care from one provider to the next. However, a study published this week in the Journal of the American Medical Association demonstrates that standardizing written and verbal communication during these patient “handoffs” can substantially reduce medical errors without burdening existing workflows.
The study followed 1,255 patient admissions to two separate inpatient units at Boston Children’s Hospital—half occurring before a new verbal and written handoff program was introduced (July to September 2009) and half after (from November 2009 to January 2010).
After implementation, providers spent more time communicating face-to-face in quiet areas conducive to conversation. There were fewer omissions or miscommunications about patient data during handoffs. And medical errors decreased 45.8 percent. Full story »
The Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.
According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals. Full story »
Despite recent national pediatric guidelines recommending identification and treatment of children with familial hypercholesterolemia, the use of lipid-lowering treatment has been flat over the past decade in real-world pediatric practice, finds a large multicenter study.
Justin Zachariah, MD, MPH, a pediatric cardiologist at Boston Children’s Hospital, presented the findings this week at the 2013 American Heart Association (AHA) Scientific Sessions. He believes they dispel some critiques of the recent guidelines, particularly concerns that more screening would result in overmedicating the pediatric population.
Extending beyond 2008 recommendations from the American Academy of Pediatrics, the 2011 National Heart, Lung and Blood Institute’s pediatric guidelines call for universal lipid screening and medical treatment for children at highest risk for early cardiovascular disease. One such high-risk condition is familial hypercholesterolemia, a genetic disorder characterized by high blood cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, or “bad” cholesterol) and early coronary events. Full story »
Morning rounds on the pediatric cardiac intensive care unit.
Registered nurses (RNs) remain the largest group of health care providers and typically account for the greatest share of most U.S. hospitals’ operating budgets, about 60 percent. In adult hospitals, research has shown a consistently positive effect
of increasing percentages of nurses with baccalaureate educations, and linked increased RN staffing and healthy work environments with improved patient outcomes.
However, this assessment has not been conducted in children’s hospitals—until now.
In a study in the Journal of Nursing Administration, nursing leaders from 38 free-standing children’s hospitals explored which nursing and organizational characteristics influence mortality for children undergoing congenital heart surgery.
The study, involving 20,407 pediatric patients and 3,413 pediatric critical care nurses, was led by Patricia Hickey, PhD, MBA, RN, from the Heart Center at Boston Children’s Hospital.
In pediatrics, congenital heart disease is the most common birth defect requiring surgical intervention for survival. Due to their critical care needs, these patients consume a disproportionate share of U.S. hospital resources. Full story »
For Eric Fleegler, MD, MPH, good legislation is good medicine. Just as the right diagnosis and treatment can make the difference in a child’s health, laws and regulations that address public health issues can reduce the incidence of injuries or disease. Fleegler, an emergency medicine physician at Boston Children’s Hospital, believes that doctors, nurses and other medical professionals can—and should—get involved in public policy debates.
“They are not only looked at as experts, they are also respected as people who represent the rights of children,” Fleegler says.
Health policy experts
For years, Fleegler has represented the rights of children by offering expert testimony to legislators and committees, and by advocating for laws and regulations that address issues like gun violence, food insecurity and asthma in inner-city school children.
“We can lose sight of the value we have in the legislative world,” he says. “In my experience, legislators ask questions of physicians because they want to interact with a doctor and understand what’s really happening. We can bring insight.” Full story »
It’s music to the ear of any cancer patient: “Your scans are clear.” It means you’ve won, and the treatments you’ve endured have driven cancer from your body.
But once you hear those four magic words, are you also free of the need for future scans? There’s an argument to be made that continued scanning or surveillance imaging is a good thing. After all, if you have a relapse, you want to detect it as early as possible.
But that argument may not hold up in the face of data. Continued imaging can be expensive, can expose survivors to additional radiation, can have false positive results leading to additional worry and unnecessary medical care, and may not be any better at detecting tumor relapses than a physical exam or simply a survivor’s feeling that something is “wrong.”
Stephan Voss, MD, PhD, the director of Nuclear Medicine and Molecular Imaging and chief of Oncologic Imaging at Boston Children’s Hospital, decided to crunch the numbers, using Hodgkin lymphoma (HL) as a model for testing whether post-treatment surveillance with computed tomography (CT) scans makes clinical sense. His conclusion: not really.
“The conventional wisdom is that early detection of relapse means that we spare the patient side effects and poorer outcomes,” Voss says, referring to the belief that HL survivors should have a follow-up CT scan every year for up to five years after treatment. “But with Hodgkin disease, that’s not the case.” Full story »
(Diane Campbell Payne, used with permission)
Naomi Fried, PhD, is chief innovation officer at Boston Children’s Hospital. This post is adapted from her remarks at the Connected Health Symposium on October 24, 2013. She tweets @NaomiFried.
In the health care industry, we rely heavily on regulations to ensure the safety of our patients, procedures and drugs. New national health care regulations can even spur innovation in care delivery, but in the case of telehealth, they can be an impediment.
Telehealth, the remote delivery of care via computers, mobile devices, videoconferencing and other technologies, has great potential to improve the patient experience and reduce health care costs by removing the barriers of brick and mortar. At Boston Children’s Hospital, the Innovation Acceleration Program’s pilot telehealth programs have focused on both direct patient care and virtual clinician-to-clinician consultations.
Unfortunately, most states’ regulations are limiting providers’ ability to broadly offer telehealth services. Full story »
Because unplanned hospital readmissions put patients at risk, burden families and add to the cost of health care, many medical professionals are taking steps to reduce them. To push the effort, new Centers for Medicare & Medicaid Services (CMS) rules impose escalating penalties that decrease a hospital’s Medicare payments if patients are readmitted within 30 days of discharge.
Last week on Vector, we reported research suggesting that some readmissions may be incorrectly classified as preventable (and thereby penalized), particularly at pediatric hospitals. But what steps can be taken to reduce the number of truly preventable readmissions?
One step, highlighted here last week, is making post-discharge communications much simpler with texts and emails. But how can hospitals make sure their patients are ready to go home? A new study published in the International Journal for Quality in Health Care finds that in pediatric settings, the answers may be found in parents’ perceptions, which turn out to be good predictors of an unplanned readmission. Full story »
One-size-fits-all metrics don't appear to fit children's hospitals.
Government agencies in charge of determining what constitutes efficient, quality health care have taken to looking at hospital readmission rates. On the surface, this makes perfect sense: If patients are continually being readmitted to a hospital, that hospital must not be doing enough to treat patients appropriately on the first go-round. But new research indicates that relying too heavily on readmissions as an efficiency metric may wrongly put some health care institutions—particularly pediatric hospitals—at a disadvantage.
At the American Academy of Pediatrics (AAP) meeting this week, a team led by James Gay, MD, medical director of Utilization and Case Management at Monroe Carell Jr. Children’s Hospital at Vanderbilt, presented research involving more than 1 million patients cared for at children’s hospitals across the country. The team, which also included Boston Children’s Mark Neuman, MD, MPH, posed this question: If hospital ratings are going to be tied so strongly to readmission rates, shouldn’t that rating system recognize the difference between potentially preventable readmissions (PPRs) and those that are unavoidable?
Currently, some state Medicaid programs use software such as 3M PPR, developed for this exact purpose. Like the basic idea that inspired it, the 3M PPR system works well on principle. However, according to Gay and colleagues, it doesn’t capture all the nuances of what makes a readmission preventable or not. Full story »