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Gal DB, Rodts M, Hills BK, Kipps AK, Char DS, Pater C, Madsen NL. Caregiver and provider attitudes toward family-centred rounding in paediatric acute care cardiology. Cardiol Young 2024; 34:67-72. [PMID: 37198962 DOI: 10.1017/s104795112300118x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Family-centered rounding has emerged as the gold standard for inpatient paediatrics rounds due to its association with improved family and staff satisfaction and reduction of harmful errors. Little is known about family-centered rounding in subspecialty paediatric settings, including paediatric acute care cardiology.In this qualitative, single centre study, we conducted semi-structured interviews with providers and caregivers eliciting their attitudes toward family-centered rounding. An a priori recruitment approach was used to optimise diversity in reflected opinions. A brief demographic survey was completed by participants. We completed thematic analysis of transcribed interviews using grounded theory.In total, 38 interviews representing the views of 48 individuals (11 providers, 37 caregivers) were completed. Three themes emerged: rounds as a moment of mutual accountability, caregivers' empathy for providers, and providers' objections to family-centered rounding. Providers' objections were further categorised into themes of assumptions about caregivers, caregiver choices during rounds, and risk for exacerbation of bias and inequity.Caregivers and providers in the paediatric acute care cardiology setting echoed some previously described attitudes toward family-centered rounding. Many of the challenges surrounding family-centered rounding might be addressed through access to training for caregivers and providers alike. Hospitals should invest in systems to facilitate family-centered rounding if they choose to implement this model of care as the current state risks erosion of provider-caregiver relationship.
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Affiliation(s)
- Dana B Gal
- Division of Pediatric Cardiology, Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Megan Rodts
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Brittney K Hills
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Alaina K Kipps
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Danton S Char
- Stanford Center for Biomedical Ethics, Palo Alto, CA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Colleen Pater
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicolas L Madsen
- Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas. Texas, 75390, USA
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Gal DB, Pater CM, McGinty M, Lobes G, Tuemler C, Eldridge PM, Frakes B, Marcuccio E, Hanke SP, Gaies MG. Initiative to increase family presence and participation in daily rounds on a paediatric acute care cardiology unit. Cardiol Young 2024; 34:44-49. [PMID: 37138526 DOI: 10.1017/s1047951123001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit. METHODS We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures. RESULTS Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable. CONCLUSIONS Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.
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Affiliation(s)
- Dana B Gal
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Colleen M Pater
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Mackenzie McGinty
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Greta Lobes
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Christy Tuemler
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Paula M Eldridge
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Brittany Frakes
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Elisa Marcuccio
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Samuel P Hanke
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Michael G Gaies
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
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Ring LM, Cinotti J, Hom LA, Mullenholz M, Mangum J, Ahmed-Winston S, Cheng JJ, Randolph E, Harahsheh AS. A Quality Improvement Initiative to Improve Pediatric Discharge Medication Safety and Efficiency. Pediatr Qual Saf 2023; 8:e671. [PMID: 37434598 PMCID: PMC10332828 DOI: 10.1097/pq9.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Medication errors are a leading safety concern, especially for families with limited English proficiency and health literacy, and patients discharged on multiple medications with complex schedules. Integration of a multilanguage electronic discharge medication platform may help decrease medication errors. This quality improvement (QI) project's primary aim (process measure) was to increase utilization in the electronic health record (EHR) of the integrated MedActionPlanPro (MAP) for cardiovascular surgery and blood and marrow transplant patients at hospital discharge and for the first clinic follow-up visit to 80% by July 2021. Methods This QI project occurred between August 2020 and July 2021 on 2 subspecialty pediatric acute care inpatient units and respective outpatient clinics. An interdisciplinary team developed and implemented interventions, including integration of MAP within EHR; the team tracked and analyzed outcomes for discharge medication matching, and efficacy and safety MAP integration occurred with a go-live date of February 1, 2021. Statistical process control charts tracked progress. Results Following the implementation of the QI interventions, there was an increase from 0% to 73% in the utilization of the integrated MAP in the EHR across the acute care cardiology unit-cardiovascular surgery/blood and marrow transplant units. The average user hours per patient (outcome measure) decreased 70% from the centerline of 0.89 hours during the baseline period to 0.27 hours. In addition, the medication matching between Cerner inpatient and MAP inpatient increased significantly from baseline to postintervention by 25.6% (P < 0.001). Conclusion MAP integration into the EHR was associated with improved inpatient discharge medication reconciliation safety and provider efficiency.
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Affiliation(s)
- Lisa M. Ring
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
- Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, D.C
- Department of Advanced Practice Providers, Children’s National Hospital, Washington, D.C
| | - Jamie Cinotti
- Global Services, Children’s National Hospital, Washington, D.C
| | - Lisa A. Hom
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
- Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, D.C
| | - Mary Mullenholz
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
| | - Jordan Mangum
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
| | | | - Jenhao Jacob Cheng
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
| | - Ellie Randolph
- Global Services, Children’s National Hospital, Washington, D.C
| | - Ashraf S. Harahsheh
- Children’s National Heart Institute, Children’s National Hospital, Washington, D.C
- Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington, D.C
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Arab Y, Choueiter N, Dahdah N, El-Kholy N, Abu Al-Saoud SY, Abu-Shukair ME, Agha HM, Al-Saloos H, Al Senaidi KS, Alzyoud R, Bouaziz A, Boukari R, El Ganzoury MM, Elmarsafawy HM, ELrugige N, Fitouri Z, Ladj MS, Mouawad P, Salih AF, Rojas RG, Harahsheh AS. Kawasaki Disease Arab Initiative [Kawarabi]: Establishment and Results of a Multicenter Survey. Pediatr Cardiol 2022; 43:1239-1246. [PMID: 35624313 PMCID: PMC9140321 DOI: 10.1007/s00246-022-02844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Studies on Kawasaki disease (KD) in Arab countries are scarce, often providing incomplete data. This along with the benefits of multicenter research collaboratives led to the creation of the KD Arab Initiative [Kawarabi] consortium. An anonymous survey was completed among potential collaborative Arab medical institutions to assess burden of KD in those countries and resources available to physicians. An online 32-item survey was distributed to participating institutions after conducting face validity. One survey per institution was collected. Nineteen physicians from 12 countries completed the survey representing 19 out of 20 institutions (response rate of 95%). Fifteen (79%) institutions referred to the 2017 American Heart Association guidelines when managing a patient with KD. Intravenous immunoglobulin (IVIG) is not readily available at 2 institutions (11%) yet available in the country. In one center (5%), IVIG is imported on-demand. The knowledge and awareness among countries' general population was graded (0 to 10) at median/interquartiles (IQR) 3 (2-5) and at median/IQR 7 (6-8) in the medical community outside their institution. Practice variations in KD management and treatment across Arab countries require solid proactive collaboration. The low awareness and knowledge estimates about KD among the general population contrasted with a high level among the medical community. The Kawarabi collaborative will offer a platform to assess disease burden of KD, among Arab population, decrease practice variation and foster population-based knowledge.
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Affiliation(s)
- Yousra Arab
- University of Sherbrooke, Sherbrooke, QC Canada
| | - Nadine Choueiter
- Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, 3415 Bainbridge Ave, Bronx, NY 10467 USA
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Nermeen El-Kholy
- Pediatric Cardiology Department, AlJalila Children’s Specialty Hospital, Dubai, United Arab Emirates
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Sima Y. Abu Al-Saoud
- Department of Pediatrics, Makassed Hospital, Faculty of Medicine, Al- Quds University, East-Jerusalem, Palestine
| | | | - Hala M. Agha
- Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Hesham Al-Saloos
- Division of Cardiology, Sidra Medicine, Doha, Qatar
- Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | | | - Raed Alzyoud
- Pediatric Immunology, Allergy, and Rheumatology Division, Queen Rania Children’s Hospital, Amman, Jordan
| | - Asma Bouaziz
- Headmaster of Children and Neonatal Department, Hôpital Régional, Ben Arous, Tunisia
| | - Rachida Boukari
- Pediatric Department, University Hospital Mustapha Bacha, Algiers University, Algiers, Algeria
| | - Mona M. El Ganzoury
- Pediatric Cardiology Division, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala M. Elmarsafawy
- Pediatric Cardiology Division, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Najat ELrugige
- Pediatric Cardiology Department, Benghazi Children Hospital, Faculty of Medicine, Benghazi University, Benghazi, Libya
| | - Zohra Fitouri
- Unit of Rheumatology, Emergency and Outpatient Department, Pediatric Hospital of Béchir Hamza of Tunis, University Tunis El Manar, 1007 Djebel Lakhedher Bab Saadoun, Tunis, Tunisia
| | - Mohamed S. Ladj
- Pediatric Department, Djillali Belkhenchir University Hospital, Algiers, Algeria
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | - Pierre Mouawad
- Pediatric Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Aso F. Salih
- Pediatric Cardiology Department/Children’s Heart Hospital- Sulaimani College of Medicine- Sulaimani University, Al-Sulaimaniyah, Iraq
| | - Rocio G. Rojas
- Clinical Research Program, Division of Pediatric Cardiology, CHU Sainte-Justine, Montreal, QC H3T 1C5 Canada
| | - Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
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Quality Improvement Initiative Increasing Early Discharges From an Acute Care Cardiology Unit for Cardiac Surgery and Cardiology Patients–Associated With Reduced Hospital Length of Stay. Pediatr Qual Saf 2022; 7:e587. [PMID: 35928019 PMCID: PMC9345632 DOI: 10.1097/pq9.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
Discharging patients from the acute care setting is complex and requires orchestration of many clinical and technical processes. Focusing on timely discharges improves throughput by off-loading ICUs and coordinating safe outpatient transitions. Our data review demonstrated most discharges occurred later in the day. We sought to improve our discharge times for cardiology and cardiovascular surgery (CVS) patients in our 26-bed inpatient acute care cardiology unit (ACCU). We aimed to increase the number of discharges between 6 am and 12 pm for cardiology and CVS patients on ACCU from 5 to 10 patients per month over 6 months and sustain.
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Gal DB, Kwiatkowski DM, Cribb Fabersunne C, Kipps AK. Direct Discharge to Home From the Pediatric Cardiovascular ICU. Pediatr Crit Care Med 2022; 23:e199-e207. [PMID: 35044343 DOI: 10.1097/pcc.0000000000002883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe direct discharge to home from the cardiovascular ICU. DESIGN Mixed-methods including retrospective Pediatric Cardiac Critical Care Consortium and Pediatric Acute Care Cardiology Collaborative data and survey. SETTING Tertiary pediatric heart center. PATIENTS Patients less than 25 years old, with a cardiovascular ICU stay of greater than 24 hours and direct discharge to home from January 1, 2016, to December 8, 2020, were included. Select data describing patients discharged from acute care internally and nationally from Pediatric Acute Care Cardiology Collaborative sites were compared with the direct discharge to home cohort. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Encounter- and patient-specific characteristics. Seven-day and 30-day readmission and 30-day mortality served as surrogate safety markers. A survey of cardiovascular ICU frontline providers assessed comfort and skills related to direct discharge to home.There were 364 direct discharge to home encounters that met inclusion criteria. The majority of direct discharge to home encounters were associated with a surgery or procedure (305; 84%). There were 27 encounters (7.4%) for medical technology-dependent patients requiring direct discharge to home. Unplanned 7-day readmissions among direct discharge to home patients was 1.9% compared with 4.6% (p = 0.04) of patients discharged from acute care internally. Readmission among those discharged from acute care internally did not differ from those at Pediatric Acute Care Cardiology Collaborative sites nationally. Frontline cardiovascular ICU providers had mixed levels of confidence in technical aspects and low levels of confidence in logistics of direct discharge to home. CONCLUSIONS Cardiovascular ICU direct discharge to home was not associated with increased unplanned readmissions compared with patients discharged from acute care and may be safe in select patients. Frontline cardiovascular ICU providers feel time constraints challenge direct discharge to home. Further research is needed to identify patient characteristics associated with safe direct discharge to home and systems needed to support this practice.Summary statistics are described using proportions or medians with interquartile ranges (IQRs) and were performed using Microsoft Excel (Microsoft, Redmond, WA). Two-sample tests of proportions were used to compare readmission frequency of the DDH cohort compared with internal and national PAC3 data using STATA Version 15 (StataCorp, College Station, TX).
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Affiliation(s)
- Dana B Gal
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - David M Kwiatkowski
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA
| | - Camila Cribb Fabersunne
- San Francisco Department of Public Health, Division of Maternal and Child Health, San Francisco, CA
| | - Alaina K Kipps
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA
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