Wallace Crandall1, J Terrance Davis2, Jennifer Dotson3, Charles Elmaraghy4, Mike Fetzer5, Don Hayes6, Edwin Horwitz7, Amy Kogon8, Randal Olshefski9, Hiren Patel8, Richard J Brilli10. 1. Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital/Department of Pediatrics, Columbus, OH. 2. Hospital Administration, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH. Electronic address: terry.davis@nationwidechildrens.org. 3. Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital/Department of Pediatrics, Columbus, OH; The Research Institute at Nationwide Children's Hospital, Columbus, OH. 4. Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH; Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University College of Medicine, Columbus, OH. 5. Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH. 6. Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH. 7. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Hematology/Oncology/Bone Marrow Transplantation, Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, OH. 8. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH. 9. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Division Hematology/Oncology/Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH. 10. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; Divison of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Abstract
OBJECTIVE: The Cancer Care Index (CCI), a single metric that sums the number of undesirable patient events in a given time frame (either preventable harm events or missed opportunities to provide optimal care), resulted in a 42% improvement in performance. Our objective was to test the index concept in other service lines to determine whether similar performance improvement occurred. STUDY DESIGN: Care indices were developed and introduced in 3 additional service lines: Nephrology (Chronic Kidney Disease Care Index; CKDCI), Pulmonology (Lung Transplantation Care Index; LTCI), and Otolaryngology (Tracheostomy Care Index; TCI). After reaching agreement on specific harms to be avoided and elements of optimal care that should be reliably delivered, these items were compiled into indices that were updated monthly. Reports included each element individually and the total for all elements. Baseline performance was calculated retrospectively for the previous year. RESULTS: Significant improvement in performance occurred in each program following implementation of the clinical indices. The CKDCI was decreased by 63.2% (P < .001), the LTCI was decreased by 89.5% (P < .001), and the TCI was decreased by 53.0% (P < .001). Surveyed staff indicated satisfaction with use of the metric. CONCLUSIONS: Clinical indices are useful for evaluating and managing the overall reliability of a program's ability to deliver optimal care, and are associated with improved clinical performance and satisfaction by service line staff when incorporated into a program's operation.
OBJECTIVE: The Cancer Care Index (CCI), a single metric that sums the number of undesirable patient events in a given time frame (either preventable harm events or missed opportunities to provide optimal care), resulted in a 42% improvement in performance. Our objective was to test the index concept in other service lines to determine whether similar performance improvement occurred. STUDY DESIGN: Care indices were developed and introduced in 3 additional service lines: Nephrology (Chronic Kidney Disease Care Index; CKDCI), Pulmonology (Lung Transplantation Care Index; LTCI), and Otolaryngology (Tracheostomy Care Index; TCI). After reaching agreement on specific harms to be avoided and elements of optimal care that should be reliably delivered, these items were compiled into indices that were updated monthly. Reports included each element individually and the total for all elements. Baseline performance was calculated retrospectively for the previous year. RESULTS: Significant improvement in performance occurred in each program following implementation of the clinical indices. The CKDCI was decreased by 63.2% (P < .001), the LTCI was decreased by 89.5% (P < .001), and the TCI was decreased by 53.0% (P < .001). Surveyed staff indicated satisfaction with use of the metric. CONCLUSIONS: Clinical indices are useful for evaluating and managing the overall reliability of a program's ability to deliver optimal care, and are associated with improved clinical performance and satisfaction by service line staff when incorporated into a program's operation.
Authors: Justin A Indyk; Don Buckingham; Kathryn S Obrynba; Chris Servick; Kajal K Gandhi; Alyssa Kramer; Manmohan K Kamboj Journal: Pediatr Qual Saf Date: 2020-09-25
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