Quality and Safety Boards: A Lesson in Proactive Pediatric Health
By Brian Jacobs, MD, VP, CMIO & CIO, Children's National Health System
The notion that we as healthcare providers should anticipate the needs of patients and act on the latest data might seem self-evident. However, as many of us know, it can be difficult to put that philosophy into practice while balancing the needs and perspectives of all those involved in care decisions. The volume and complexity of essential healthcare information can be overwhelming for clinicians balancing the care of multiple patients in need.
Children’s National Health System has been a leader in pediatric health for years, and one of the drivers of that success across the organization has been a focus on high quality, safe and proactive pediatric healthcare. As a pediatric critical care specialist and VP, CMIO and CIO, I have had many opportunities to work with organizational leaders, clinical and technical staff members to design approaches to care that allow us to achieve and sustain that balance.
To that end, Children’s National launched the Bear Institute in September 2013. The Bear Institute is a pediatric health information technology partnership with the Cerner Corporation designed to provide value-driven care with a focus on operational excellence and innovation. It serves as a health IT innovation laboratory, where clinicians, developers, programmers and engineers work together to strengthen our health IT infrastructure and accelerate the advancement of the quality initiatives underway at Children’s National. Through the development and implementation of health IT programs, the Bear Institute supports the larger Children’s National vision – “To help create a future where every child grows to their highest level of health and potential.”
“One approach that illustrates our success in improving care is through the use of real-time hospital unit-based quality and safety boards”
One approach that illustrates our success in improving care is through the use of real-time hospital unit-based quality and safety boards visible by clinicians, administrators, patients and family members throughout all care delivery units in the organization. The boards display important patient safety and quality measures which can be rapidly acted upon to improve care. For example, in the Pediatric ICU, the boards display each patient’s risk for deep vein thrombosis, ventilator-acquired pneumonia, unplanned tracheal extubation, urinary tract infection, and catheter-associated blood stream infections among others. The large-scale, digital monitors refresh every five minutes, allowing physicians, nurses, patients and family members to directly engage in the assessment of important safety and quality measures and, most importantly, deliver prompt preventative care for every patient.
We have noted improvements in care quality in the cardiac ICU through the use of quality and safety boards, including:
• Lower percentage of patients with urinary catheters in place for more than 96 hours: from 11 percent to 4 percent
• Decrease in the rate of Catheter Associated UTIs by 31 percent
• Increase in completion of medication reconciliation to 92 percent from 80 percent at baseline
• Decrease in the average time from admission to treatment consent by 49 percent
The quality and safety boards have also promoted transparency, accountability and alignment among our staff members and the patients and family members we serve.
Many of us have been in the position to manage a healthcare event involving a loved one. I would wager that even those of us who have built our careers working in healthcare organizations have faced difficulties, at one point or another, in obtaining new information about care and understanding the implications of clinical data and procedures. At Children’s National, we recognized early in the process of developing our quality and safety boards that promoting the transparent use of real-time data improves the care management process for families and reduces feelings of uncertainty.
We make the quality boards available to each family or caregiver involved in the treatment process. Having convenient, unrestrained access to that information encourages families to speak up and engage with care teams, and it helps them to advocate for the best care for their loved one. The public-facing versions of the quality dashboards also promote trust and communication between clinicians, families and patients.
The quality and safety boards also support accountability and, by doing so in real-time, enable care teams to adjust their approaches and procedures quickly and efficiently. We designed the quality boards to emphasize live situational awareness of documentation compliance and adherence to established clinical guidelines and best practices. As a result, we can track the care process from start to finish.
Encouraging clinicians to immediately flag challenges they are encountering or questions they have about a particular patient, the boards also promote unity among members of the care teams and enable staff members to fully embrace their roles. We want to ensure that everyone involved in the care of our patients is empowered to speak up and is comfortable holding themselves accountable. Real-time data allows us to do just that.
To support the Children’s National Health System vision, we needed to align the quality and safety boards with established safety standards from the Joint Commission, and then make the data actionable for clinicians. Besides the aforementioned measures, the boards are focused on:
• Reducing blood stream infections
• Decreasing risk of unplanned extubation
• Decreasing risk of ventilator-associated pneumonia
• Using incentive spirometry to support breathing and lung recovery
• Sharing pediatric warning signs
• Documenting all care delivery
• Improving medical reconciliation
• Early identification of patients at risk for deterioration
By aligning the quality boards program with these standards, we drive adoption of technology and clearly outline how to aid clinicians in meeting patient health needs.
Overall, the quality and safety boards have strengthened the connections between the various members of the patient care continuum, empowered our staff members and the families we serve, and facilitated knowledge-driven care and continuous learning among clinicians. In the months ahead, we plan to expand the use of the technology throughout the organization, regionally and nationally to continue to share our insights so that other hospitals can benefit from what we have learned.