Report From the Section
Ricardo A. Quinonez, MD, FAAP
At a recent medical conference I met a primary care pediatrician (PCP) who was unfamiliar with the pediatric hospital medicine (PHM) movement. I proudly explained our growth, expansion, evidence of our effectiveness and the ongoing debate over possible certification. He then asked me a question which left me without a good answer: “what about continuity of care?” He explained that his only interaction with hospitalists had been when a relative had recently been hospitalized and was under the care of an adult hospital medicine group. During a 5 day hospital stay, his relative had been under the care of at least 4 different hospitalists. It was inconceivable to him that every time a new physician showed up to the bedside the family had to repeat the entire story and start the doctor-patient relationship over again.
The phrase, continuity of care, usually applies to our primary care colleagues who see their patients from birth to young adulthood, in a series of outpatient encounters. It makes sense to apply this to the inpatient experience, where ideally, a single hospitalist cares for the patient during the entire hospitalization. Unfortunately, the evolving work schedules of pediatric hospitalists may compromise our ability to provide such continuity. In addition to covering gaps created by resident work hour restrictions, increasing numbers of PHM programs now work “in-house” 24/7, creating a shift work mentality that can undermine continuity. Yet it has been shown that not only is continuity in the hospital achievable, continuity of care can improve outcomes such as length of stay and costs.1
Certainly this pediatrician's story brings up concerns about adequate handoffs, an issue which hospitalists care much about and are working hard to standardize and improve. Efforts such as the Pediatric Research in the Inpatient Setting's (PRIS) I-PASS study,2 which champions a handoff bundle for residents, will hopefully improve handoffs within the inpatient setting. The VIP network is now in phase 2 of its “transitions of care” project, improving transitions from the inpatient to the outpatient setting.
Continuity of care, handoffs and transitions of care are all part of the continuum of care. Hospitalists are striving to create seamless transitions along the continuum, a daunting challenge. In challenge lies opportunity. In my opinion, pediatric hospitalists are thankful for the opportunity, and we are definitely up for the challenge.
ID Band Collaborative
The American Board of Pediatrics (ABP) has awarded maintenance of certification (MOC) part 4 credit to pediatric hospitalists who participated in an innovative learning collaborative which sought to improve patient safety by reducing ID band errors in hospitalized children. As reported in Pediatrics, participants from 6 hospitals organized in 2009 at the annual Pediatric Hospital Medicine meeting in an attempt to imitate and spread the successful single site intervention spearheaded by Dr. Paul Hain and colleagues at Monroe Carell Jr. Children's Hospital at Vanderbilt. The objective was to reduce by half the pediatric patient identification band error rate, defined as absent, illegible or inaccurate ID bands, across a quality improvement learning collaborative of hospitals in one year.
Dr. Shannon Phillips, Patient Safety Officer at the Cleveland Clinic led the learning collaborative, which also included: Our Lady of the Lake Regional Medical Center in Baton Rouge, LA; Scottsdale Healthcare in Scottsdale, AZ; The Children's Hospital in Denver, CO; Riley Hospital for Children in Indianapolis, IN; and New York Hospital, Queens, NY.
Between September 2009 and September 2010, the collaborative audited 11377 patients for ID band errors. Interventions included education of frontline staff regarding correct ID bands as a safety strategy; a change to softer ID bands, including “luggage tag” type ID bands for some patients; and partnering with families and patients through education. The ID band failure rate decreased from 17% to 4.1%, a relative reduction of 77%. This significant reduction across hospitals demonstrated that safety improvements tested in a single institution can be disseminated to improve quality of care across large populations of children.
Through the sponsorship of the American Academy of Pediatrics' Value in Inpatient Pediatrics Network/Quality Improvement Innovations Network, the collaborative was able to apply for and obtain ABP MOC part 4 credit. “Collaborative learning and improvement of care is the business of hospitalists,” said Dr. Phillips. “Providing MOC credit to validate the work done in this and other collab-oratives going forward brings a new value to MOC for a hospitalist.”
- Copyright © 2012 by the American Academy of Pediatrics