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 »
Do you have a fever?
Do you have a cough?
If you’re sitting at home with a sore throat, your answers to those two questions could be enough to tell whether you should see a doctor for a strep test, thanks to a new risk measure created by Kenneth Mandl, MD, MPH, and Andrew Fine, MD, MPH, at Boston Children’s Hospital.
Called a “home score,” the measure combines the two questions above, your age, and data on the level of strep activity in your geographic area. The basic idea is that your symptoms, plus the big picture of what’s happening in your neighborhood, is a strong enough predictor to for you to go to the doctor for a throat swab.
Thought it’s just a research tool for now, if it were it were packaged into an app and fed the right data (localized strep test results from a health center or medical testing company, for example), the home score could allow someone with a sore throat to make an informed decision about whether they should consider going to the doctor.
Full story »
Elizabeth Hait, MD, MPH
Finding meals a whole family can eat—including kids with food allergies—can be like solving a Rubik’s cube.
, wears many hats. She’s a physician, researcher, wife and mother just to name a few.
But she never fancied herself an innovator—until recently. After participating in Hacking Pediatrics, sponsored by Boston Children’s Hospital in collaboration with MIT’s H@cking Medicine, she now sees potential innovations and innovators everywhere.
“To be an innovator, you don’t need to be extraordinary, you just need to recognize that a problem exists and be dedicated to fixing it,” she says.
The problem she took to last month’s Hacking Pediatrics Hackathon stems directly from her work. As co-medical director at Boston Children’s Eosinophilic Gastrointestinal Disease (EGID) Program, which treats specific food allergies causing gastrointestinal inflammation, she sees families constantly struggling to find new (and healthy) meals that won’t trigger an allergic reaction in their kids.
“Many of our patients can only safely eat a handful of foods, so feeding them with any kind of variety is extremely hard,” she says. “Then if you factor in the likes, dislikes and other food intolerances that often exist in a family, just planning one family meal can feel like a nightmare.” Full story »
Kelly Dunn, a pediatric nurse practitioner in Medicine Patient Services at Boston Children’s Hospital, is primarily focused on helping families with hospital discharge and improving patient throughput.
A child hospitalized on 9 East, a general medical floor at Boston Children’s Hospital, was nearly ready to go home. The discharge order was written, and prescriptions were sent to the pharmacy. The staff nurse and I completed discharge teaching, competing with a very wiggly toddler for her tired mother’s attention.
Before this family went home, I had one more question: Would you like to receive a text message or email to check up on you once you are home?
Within a minute or two, I had entered the mom’s contact information and her preferred mode of communication (a text message to her cell phone) on an iPad. The family left, reassured to have a way of reaching a nurse familiar with their hospitalization should a problem or question arise at home—and pleased to have the option. 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 »
Hackathons are quickly growing beyond Red Bull- and Dorito-fueled code-fests into fertile grounds for new technologies and products that potentially could improve medicine and health care.
But beyond individual events, could hackathons signal the beginnings of a new ecosystem for medical innovation?
That’s what groups like MIT’s H@cking Medicine, Brigham and Women’s Hospital (BWH)’s new iHub and the New Media Medicine group at the MIT Media Lab are betting on. By tapping the same creative entrepreneurial energy that hackathon culture has brought to the technology industry, they believe they can fundamentally reimagine health care, one device, app and system at a time.
“The Boston area is the most fertile ground for medical innovation you could ever imagine,” says Michael Docktor, MD, a gastroenterologist at Boston Children’s and one of the organizers, with the H@cking Medicine team, of this weekend’s Hacking Pediatrics hackathon. “We need to make the case with the local medical and technology community that hackathons are a viable way of innovating in this day and age, that this is the way we ought to be innovating.” Full story »
Israel Green-Hopkins, MD, is a second-year fellow in Pediatric Emergency Medicine at Boston Children’s Hospital and a fierce advocate for innovation in health information technology, with a passion for design, mobile health, remote monitoring and more. Follow him on Twitter @israel_md.
The Centers for Medicare & Medicaid Services (CMS) defines patient engagement as having two primary objectives: to enable patients to “view online, download and transmit their health information” and to enable providers to conduct secure messaging with patients.
In 2007, focusing largely on these goals, Microsoft launched HealthVault—a Web-based electronic health record designed to fit the needs of both patients and providers. Countless private and public institutions have followed, including Boston Children’s Hospital.
But aside from satisfying regulatory requirements, are these interventions the improved engagement that patients are demanding? How can we be transformative in our approach to care and create an environment that is receptive to the engaged patient?
We first need to reconsider what it means to maneuver through the health care system as a patient. Full story »
Boston Children’s Hospital convened the National Pediatric Innovation Summit + Awards 2013 with an ambitious goal: to bring together thought leaders to address the toughest challenges in pediatric health care. During the two-day summit, a series of panels and town hall discussions sparked dynamic dialogue.
While the summit was designed as a forum for ongoing discussion and relationship building, five key takeaways have emerged. Full story »