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Journal of Pediatrics, The

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Clinical Indices Can Standardize and Monitor Pediatric Care: A Novel Mechanism to Improve Quality and Safety - 31/01/18

Doi : 10.1016/j.jpeds.2017.09.073 
Wallace Crandall, MD, MMM 1, 2, J. Terrance Davis, MD 3, * , Jennifer Dotson, MD, MPH 2, 4, Charles Elmaraghy, MD 5, 6, Mike Fetzer, BSISE 1, Don Hayes, MD, MS 7, 8, 9, Edwin Horwitz, MD, PhD 8, 10, Amy Kogon, MD, MPH 8, 11, Randal Olshefski, MD 8, 12, Hiren Patel, MD 8, 11, Richard J. Brilli, MD, FAAP, MCCM 8, 13
1 Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH 
2 Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital/Department of Pediatrics, Columbus, OH 
3 Hospital Administration, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH 
4 The Research Institute at Nationwide Children's Hospital, Columbus, OH 
5 Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, OH 
6 Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University College of Medicine, Columbus, OH 
7 Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH 
8 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 
9 Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH 
10 Division of Hematology/Oncology/Bone Marrow Transplantation, Center for Childhood Cancer and Blood Diseases, Nationwide Children's Hospital, Columbus, OH 
11 Division of Pediatric Nephrology, Nationwide Children's Hospital, Columbus, OH 
12 Division Hematology/Oncology/Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH 
13 Divison of Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 

*Reprint requests: J. Terrance Davis, MD, Nationwide Children's Hospital, 700 Children's Drive – A6454, Columbus, OH 43205.Nationwide Children's Hospital700 Children's Drive – A6454ColumbusOH43205

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.

Le texte complet de cet article est disponible en PDF.

Keywords : clinical index, clinical indices, quality improvement, performance improvement, lung transplant, chronic kidney disease, tracheostomy

Abbreviations : CCI, CKD, CKDCI, LTCI, PHI, QI, TCI


Plan


 The authors declare no conflicts of interest.


© 2017  Elsevier Inc. Tous droits réservés.
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Vol 193

P. 190 - février 2018 Retour au numéro
Article précédent Article précédent
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