An Assessment of Pediatric Inpatient Quality and Safety at Monroe Carell Jr. Children's Hospital at Vanderbilt Utilizing the Leapfrog Hospital Survey Open Access

Schlafly, Stacey Morgan (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/6395w740x?locale=en
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Abstract

Background: Recent research found that as many as 400,000 adult and pediatric Americans prematurely die each year as a result of preventable medical errors in hospitals. Efforts to improve inpatient quality and patient safety are critical to address this issue. The Leapfrog Hospital Survey is one such nationally recognized standard that encourages hospitals to evaluate and report their progress towards implementing evidence-based safety practices shown to save patient lives.

Purpose: The purpose of this study was to determine compliance with national performance measures of quality and safety, including prevention of medication errors, appropriate ICU physician staffing, evidence-based steps to avoid harm, managing serious errors and safety-focused scheduling.This assessment would allow for the identification of gaps to initiate targeted remediation, as well the identification of strengths in order to reinforce successes.

Methods: A mix-method approach was used to assess processes, policies, and outcomes. Standardized interviews were conducted with identified hospital personnel. Information was compiled into a uniform tracking tool and analyzed against Leapfrog survey questions. Infection data was collected from the organization's reporting system and analyzed in accordance with Leapfrog's methodology. Utilizing Leapfrog's scoring algorithm, the anticipated publicly reported outcome for each key measure was computed. Results were submitted to Leapfrog and benchmarked against 2012 Leapfrog Top Hospitals.

Results: Children's Hospital fully meets Leapfrog's standards for the computerized physician order entry (CPOE), ICU physician staffing (IPS), National Quality Forum (NQF) Safe Practices, Managing Serious Errors - Never Events Policy, and Safety Focused-Scheduling sections. The hospital achieved substantial progress for the Managing Serious Errors - Central Line Associated Blood Stream Infection (CLABSI) section and some progress for the Managing Serious Errors - Catheter Associated Urinary Tract Infection (CAUTI) section. The national comparison showed that Children's Hospital is comparable to 2012 Leapfrog Top Hospitals.

Conclusions: Children's Hospital has successfully implemented the majority of Leapfrog's best practices. Implementation of these standards demonstrates that the organization has adopted clinical care processes to reduce pediatric inpatient preventable harm. Improvement in CLABSI and CAUTI rates will further improve patient outcomes. Finally, the national comparison shows that Children's Hospital has a high likelihood of making the 2013 Top Hospital list.

Table of Contents

CHAPTER 1: INTRODUCTION

Background (1)

Problem Statement (3)

Purpose Statement (5)

Research Questions (6)

Significance Statement (7)

Definition of Survey Components (7)

Basic Hospital Information (8)

Computerized Physician Order Entry (CPOE) (8)

ICU Physician Staffing (IPS) (8)

National Quality Forum (NQF) Safe Practices (8)

Managing Serious Errors - Never Events (8)

Managing Serious Errors - Central Line Associated Blood Stream Infections (CLABSIs) (8)

Managing Serious Errors - Catheter Associated Urinary Tract Infections (CAUTIs) (9)

Safety-Focused Scheduling (9)

Definition of Terms (9)

Summary (10)

CHAPTER 2: REVIEW OF LITERATURE

Introduction (11)

Inpatient Quality and Patient Safety (11)

Pediatric Inpatient Quality and Patient Safety (15)

Inpatient Quality and Patient Safety Public Reporting (18)

Summary of Current Problems and Study Relevance (20)

CHAPTER 3: METHODOLOGY

Introduction (22)

Population and Sample (22)

Timeframe (23)

Research Design (24)

Procedures (27)

Instruments (31)

Data Analysis (32)

Limitations (33)

Summary (34)

CHAPTER 4: RESULTS

Introduction (35)

Findings (35)

CPOE (35)

IPS (36)

NQF Safe Practices (37)

Managing Serious Errors - Never Events (48)

Managing Serious Errors - CLABSI (49)

Managing Serious Errors - CAUTI (51)

Safety-Focused Scheduling (52)

Strengths and Opportunities for Improvement (53)

National Comparison (53)

Summary (54)

CHAPTER 5: CONCLUSIONS, RECOMMENDATIONS, AND IMPLICATIONS

Introduction (56)

Summary of Study (56)

Conclusions (57)

Recommendations and Implications (58)

REFERENCES (61)

APPENDICES

Appendix 1. Basic Hospital Information (67)

Appendix 2. Survey Overview and Timeline Presentation (69)

Appendix 3. Survey Accountability and Response Tracking Grid (72)

Appendix 4. Presentation Summary of Expected Survey Results, Strengths and Opportunities for Improvement (77)

Appendix 5. NQF Safe Practice Evidence Tracking Matrix (88)

Appendix 6. Managing Serious Errors - CLABSI and CAUTI Data (95)

List of Tables

Table 1. Survey Timeframes (24)

Table 2. Safety-Focused Scheduling Definitions (32)

Table 3. Safe Practice #1 - Leadership Structures and Systems (37)

Table 4. Safe Practice #2 - Culture, Measurement, Feedback, and Intervention (38)

Table 5. Safe Practice #3 - Teamwork Training and Skill Building (40)

Table 6. Safe Practice #4 - Identification and Mitigation of Risks and Hazards (41)

Table 7. Safe Practice #9 - Nursing Workforce (43)

Table 8. Safe Practice #17 - Medication Reconciliation (43)

Table 9. Safe Practice #19 - Hand Hygiene (45)

Table 10. Safe Practice #23 - Prevention of Ventilator Associated Complications (46)

Table 11. CLABSI Data by ICU (50)

Table 12. CAUTI Data by ICU (51)

List of Figures

Figure 1. National Comparison Matrix (55)

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