Obese children who regularly participate in CHOC Children’s mobile asthma program could realize good control of their asthma, a retrospective study of more than 1,200 patients reveals.
Study findings showed no difference in the time it took for morbidly obese children and children with normal weights to reach asthma control – so long as they didn’t exceed 90 days between Breathmobile visits.
Dr. Stanley Galant, CHOC allergist/immunologist and Breathmobile medical director, presented these findings at the American Academy of Allergy, Asthma & Immunology (AAAAI) recent annual meeting. This work, “Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile,” was also published in the Annals of Allergy, Asthma & Immunology.
The study examined 1,204 children ages 3 to 18 who were diagnosed by a physician with asthma between 2003 and 2012. Of the patients, more than half were considered overweight, obese or morbidly obese.
About 80 percent of Breathmobile patients achieved well-controlled asthma by their third visit. Additionally, participants across all body mass index (BMI) categories saw at least a 60 percent reduction in the likelihood of emergency department visits, hospitalizations, school absences and exercise limitations, even without a change in their BMIs.
CHOC’s Breathmobile is the only mobile asthma clinic dedicated to serving preschool and school-aged children in Orange County. An important community service, it removes barriers for children and their families who may be unable to travel or pay for preventive asthma care.
The Breathmobile’s two 36-foot RV-style clinics travel to 22 schools and community sites providing asthma care, diagnosis and education. Each location is visited every four to six weeks, providing children with comprehensive follow-up care from a familiar team until their asthma is controlled.
In his presentation, Dr. Galant attributed the Breathmobile’s success to cultural compatibility; patient access to community-based specialty care; adequate education for self-management; and most important, continuity of care, particularly for patients considered morbidly obese.
One year ago, a group of CHOC Children’s physicians gathered to begin the process of defining and building a meaningful wellness program throughout the health system.
As many know, physician burnout has become of great concern, and we are only beginning to appreciate the scope of this phenomenon, including the impact of burnout on ourselves, our patients and our colleagues, in addition to the complexity of issues involved. More importantly, we struggle with identifying the signs and symptoms leading to burnout, and how best to address them.
A recent survey of more than 15,000 physicians found that 44 percent of physicians reported symptoms of burnout, 11 percent reported subclinical depression, and 4 percent reported clinical depression. The gender disparity is notable, with 39 percent of males compared to 50 percent of female physicians experiencing burnout. The factors that lead to burnout are complex, and range from bureaucratic tasks and long work hours, to the challenges of electronic medical record keeping and loss of control/autonomy.
Coping strategies vary and include a number of activities, including exercise, talking with close friends and family, and ensuring adequate diet and sleep. But sometimes these approaches aren’t enough.
Depressive symptoms can begin to emerge, leading to more serious functional impairment. If left unchecked, clinical depression can result. Unfortunately, many physicians contemplate suicide. It is estimated that one doctor a day dies by suicide in the United States, the highest rate of any profession1. Even more concerning is that of those physicians who report suicide ideation, 42 percent do not tell anyone or get professional help2. Obviously, this needs to be addressed, and it needs to be addressed now.
CHOC’s Physician Wellness Subcommittee is comprised of a group of physicians dedicated to help CHOC continue to be proactive and supportive of physicians. Our mission, “To promote physician wellness to benefit ourselves and others,” captures our focus. We have been meeting since January 2018 and have established several key goals with the Stanford Medicine Model of Wellness, below, as a guide3.
Using the key areas as a guide, we have determined the following short-term goals to address each area below:
Personal Resilience: A “Wall of Gratitude” displayed in the physician dining room (PDR) will give physicians a platform to recognize colleagues in an informal format posting words of appreciation and encouragement to one another.
Efficiency of Practice: Improvements to the computer work station in the PDR will ease charting while also gaining needed nourishment. Results of an EMR survey, conducted with the ARCH Collaborative, will provide us with specific and targeted data that will allow us to address common EMR frustrations and issues to help increase our efficiency.
Culture of Wellness: We are in the beginning phases of planning a “refresh room” where physicians can go to recharge, meditate and decompress. We’ve also made some improvements to the coffee machine in the PDR.
Additional long-term goals include:
Peer-to-peer mentorship training
Optimizing EMR practices
Gathering Information from physicians willing to help to improve our culture of wellness
Another noteworthy CHOC-supported activity that helps to meet our Personal Resilience and Culture of Wellness goals includes restoring the joy of practice through the Communication in Healthcare seminar that we’ve deployed. Approximately 60 physicians and additional allied health providers have completed the patient communication program. Participants have reported extremely positive feedback and state the training has increased their sense of fulfillment, communication efficiency, and overall resulted in more meaningful relationships with their patients.
While there is much work to be done, we are grateful for the support we have received from CHOC, and are confident, with our collective effort, that a culture of wellness is achievable.
If you would like to help in our efforts, reach me at 714-509-8225.
1Anderson P. Doctors’ suicide rate highest of any profession. WebMD. May 18, 2018. Source Accessed February 28, 2019.
2Pappas S. Suicide: Statistics, warning signs and prevention. LiveScience. August 10, 2017. Source Accessed February 28, 2019.
3Bohman, B., Dyrbye, L., Sinsky, C., Linzer, M., Olson, K., Babbott, S., & Trockel, M. (2017). Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst.
The 2019 Physician Engagement Survey period for CHOC Children’s Hospital and CHOC Children’s at Mission Hospital runs April 1 to 29.
Don’t miss this opportunity to provide valuable input and feedback, which will allow CHOC Children’s to further strengthen and improve its programs and services to better meet physician needs, as well as those of CHOC patients and families.
All participants will be entered in a raffle for a chance to win one of the following prizes: a gift card for The Resort at Pelican Hill; a gift card for The Ritz-Carlton; a gift card for Mastro’s Restaurants; or a gift card for Amazon. One winner will be selected each week of the survey’s duration.
Look out for an invitation to complete the survey from Press Ganey, who will conduct the survey on behalf of CHOC. For questions, contact Jenny Huynh, physician relations specialist at CHOC, at 714-509-7965 or email@example.com.
At CHOC Children’s, we’ve worked hard to build a culture of safety, quality and collaboration. We’re proud to have cultivated an environment that not only prioritizes safety, but also emphasizes sharing and openness so that we can all learn from best practices, as well as mistakes or near misses.
So, when a leading safety organizes recognizes CHOC’s commitment to quality, it’s icing on the cake. We are thrilled to be the first pediatric facility in the world to be named a five-star hospital by the Patient Safety Movement Foundation (PSMF).
To reach this achievement, we’ve made formal commitments to all PSMF Actionable Patient Safety Solutions (APSS) – processes designed to eliminate preventable deaths – that are relevant to pediatric care.
Our collaboration with PSMF reinforces the natural tendencies within pediatric care to collaborate broadly, share readily and move quickly in evidence-based ways to constantly learn, teach and make all efforts to avoid patient harm.
Checklists remain key
All of this translates into CHOC’s belief in using checklists. Checklists work, as other industries know well. The concept of the PSMF’s APSS work. In an increasingly complex world, we just need to do the simple, proven things that lead us to our desired outcomes. And our patients and families thank us for our attention to small detail, which reaps big benefit.
We are active partners in a number of regional, state and national networks of children’s providers, patient safety organizations and specialty areas of excellence such as nursing, trauma, extracorporeal life support, and patient and employee experience – all of whom have some compendium of best practice standards.
That’s a good catch
In addition to collaborating and sharing information with our outside partners, we’re doing the same within the walls of our own campus. To move the needle on safety and quality, we all need to be open to learning, course correcting, and sharing. Our “Good Catch” program at CHOC is a great example of that.
This effort is designed to encourage employees to keep their eyes open and speak up when they notice something that could have gone wrong – without fear of punishment or retaliation. Under the program, employees who report a near miss or close call that could have harmed a patient, family member, colleague or visitor are entered into a raffle for prizes each month.
One person who submits a Great Catch – a near miss that could have harmed someone and led to a significant process improvement effort – earns a bigger prize each month.
Investing in quality, safety
We know the small investments in incentives for this program will pay off in dividends when it comes to continuing to cultivate an open and honest dialog around safety and quality at CHOC.
We believe in the power of stories and the importance of individual events, not just rates. This helps us see the impact of single instance and is consistent with our patient- and family-centered model of care.
Marking the launch of a new era for emergency transport services at CHOC Children’s, the “CHOC1” helicopter landed for the first time atop the Bill Holmes Tower at CHOC Children’s Hospital earlier this year.
In just 10 months, CHOC1 has clocked 200 flights, traveling all over Southern California, even as far north as Bakersfield, to transports critically ill patients to CHOC. On a typical afternoon, CHOC1 can fly to CHOC Children’s at Mission Hospital in a mere seven minutes, as opposed to driving for one hour in bumper-to-bumper traffic on the freeways.
The transport team is comprised of expert physicians, nurses and respiratory therapists. At the helm is Kevin Barber, lead pilot.
Throughout his 15-year career as a pilot, Kevin has flown many different types of aircraft on a variety of assignments, but he’s found the mission of flying children to be the most rewarding of his career. Prior to flying in the private sector, Kevin was a naval officer for seven years and holds a master’s degree in public administration.
“Aviation offers many different avenues but only being an emergency medical services pilot offers the ability to make a difference in your own community and help people on what is one of the worst days of their lives,” Kevin says. “Plus, the transport teams on our aircraft are top notch. There is a great amount of satisfaction flying with such professional physicians, nurses, respiratory therapists and paramedics.”
According to service partner Mercy Air, CHOC1 is the only helicopter in Southern California based out of a hospital, with four pilots and mechanics housed on site at CHOC, giving the transport team the ability to jump into action immediately.
State-of-the-art equipment on board
The helicopter is specially configured with high-tech equipment including neonatal isolettes and smart IV pumps that are loaded through the back of the aircraft and secured into a confined space.
One device in the helicopter is designed to cool critically ill newborn infants.
“To help reduce chances of neurological impairment in these sick newborn babies, cooling needs to be initiated within six hours of birth, or even earlier for better outcomes,” says Tari Dedick, manager of emergency transport services. “If we pick up a critically ill baby in the Inland Empire, we can begin cooling immediately at the bedside and continue the therapy in the helicopter on the way back to CHOC, saving precious time.”
Safety is the No. 1 priority for CHOC’s transport team.
Mercy Air maintains its Commission on Accreditation of Medical Transport Systems accreditation, which has stringent requirements about staff training, medical equipment and even what the CHOC transport team wears, including flight suits and helmets.
Among Kevin’s vast responsibilities as pilot is to closely track weight and balance restrictions. It’s often a tight squeeze in the helicopter, with every person and each device weighed prior to the flight to determine precise weight and balance.
CHOC’s transport team, using ground and air transportation, travels 100,000 miles each year to bring more than 4,000 patients to CHOC. Looking to the future, Tari says, the transport team anticipates eventually transporting trauma patients from all over Southern California to CHOC’s Level II pediatric trauma center.
“Without a doubt, CHOC1 is widening our outreach while bringing the Southern California community closer,” Tari says.