CHOC Children’s at Forefront of Leveraging Data to Enhance Quality of Care

Earlier this year, clinicians, hospital administrators, and other leaders in the medical field gathered for the American Hospital Association (AHA) Health Forum Critical Conversations in health care event in Texas, which focused on leveraging health care data to improve care.

Dr. William W. Feaster, chief health information officer at CHOC Children’s, presented on the ways CHOC is applying intelligence to data and building it into the care process to better understand quality of care and patient satisfaction scores.

Dr. William Feaster, chief health information officer at CHOC

CHOC uses Cerner’s HealtheIntentSM platform to bring in data from different sources, such as EHRs, pharmacies and payers. The system normalizes the data and builds “smart registries” for certain high-cost pediatric conditions. Dr. Feaster explained that these registries go beyond tracking patient status and outcomes for a defined population. Built on top of multiple EHRs and other sources, they extract data and then feed key patient information to clinicians at the point of care, creating a living tool, rather than a more static reporting mechanism. Adherence to clinical guidelines at CHOC has improved progressively with the advent of these smart registries.

CHOC is also using analytics to improve asthma care quality and outcomes. Additionally, CHOC is applying machine learning tools to predict readmissions and to provide this information to case managers to better manage the patient discharge process. For outpatients, CHOC is also exploring how these data science tools can help predict and prevent appointment no-shows.

To learn more about CHOC’s case study, click here for a copy of Cerner’s Transforming Health Care Delivery ebook.

Protect Infants from Next Wave of Pertussis

The California Immunization Coalition, along with Dr. Jasjit Singh, director, infection prevention and epidemiology at CHOC Children’s, recommend the following pertussis guidelines for pediatricians and their patients.

As pertussis increases to peak levels every 3- 5 years, California is due for its next epidemic by 2019. Young infants remain at highest risk of hospitalization and death from pertussis. Since 2010, at least 2,800 California infants younger than four months of age have contracted pertussis. Most of these infants have been hospitalized, and at least 18 have died.

Please consider the following measures to protect infants against pertussis:

Prevention

  • Prenatal Interview – Promote Prenatal Immunization! Remind parents and prenatal providers to give prenatal Tdap vaccine to women between 27 and 36 weeks of gestation of each pregnancy, regardless of vaccination history. Encourage vaccination of household and caregivers.
  • Administer the first dose of DTaP vaccine to infants promptly at 6-8 weeks of age. A dose as early as 6 weeks will help protect infants sooner if their mothers did not receive Tdap during pregnancy. Complete the DTaP series without delay.
  • Maternal immunization is associated with infant survival. Receipt of Tdap by mothers between weeks 27 and 36 of pregnancy and receipt of DTaP by infants prior to illness greatly reduce the risk of death from pertussis.

Presentation

Pertussis should be considered in any infant without a documented fever who presents with coryza, cough (especially paroxysmal), apnea, gagging, or post-tussive emesis.

Suspect pertussis in adolescents and adults with prolonged cough, and test and treat promptly to prevent transmission to infants.

Testing

Obtain nasopharyngeal swabs for pertussis PCR testing to confirm the diagnosis. Additional guidance is at www.cdc.gov/pertussis/clinical/diagnostic-testing/specimen-collection.html.

  • In infants, check white blood cell counts with differential – a leukemoid reaction is associated with life-threatening pertussis. A WBC count greater than 10,000 cells/mm3 with ˃50% lymphocytes should be repeated 24 hours later; increasing lymphocytosis should prompt additional monitoring and treatment. A WBC of >20,000 cells/mm3 with >50% lymphocytosis should be considered as a very strong indication that the infant has pertussis.

Treatment

Azithromycin (10mg/kg/day in a single dose for five days) for infants less than 6 months of age.

Empiric treatment is appropriate while awaiting the results of PCR testing.

Additional clinical guidance and access to consultation can be found at eziz.org/assets/docs/Pertussis-YoungInfants2011.pdf.

Further information, California case counts, and clinical guidance for pertussis can be found here.

 

CHOC Leads the Way in Implementing Food Standards for Dysphagia Patients

CHOC Children’s has emerged as a leader in implementing a new global standard for assessing food and liquid consistencies for patients with swallowing difficulties.

CHOC was one of the first pediatric hospitals nationwide to implement the International Dysphagia Diet Standardization Initiative (IDDSI), which aims to establish a standardized system of measuring and labeling the thickness of food and drink.

The goal is to ensure patient safety and improve treatment outcomes, say Jennifer Raminick and Danielle Monica, two CHOC speech language pathologists who spearheaded the system’s adoption.

Established in 2013 by a group of dysphagia specialists, IDDSI was created to standardize descriptions, consistencies and terminology for diet modifications for patients of all ages, locations and cultures.

The initiative is a marked departure from previous guidelines that relied on ambiguous labels and descriptions that often varied across institutions and providers, and required specialized, arcane equipment to measure food consistency.

IDDSI framework indicators and descriptors.
(c) The International Dysphasia Diet Standardisation Initiative 2016 @http://iddsi.org/framework/.

Conversely, IDDSI guidelines are simple and clear; testing is easy and takes 10 seconds or less; and testing tools are easily accessible to providers and at-home caregivers, Danielle and Jennifer say.

Here’s a brief explanation of the flow testing process to assess a liquid’s thickness: Cover the spout of a 10-mL syringe and fill it with the liquid. With a stopwatch in hand, open the spout for 10 seconds, and then stop the flow. The amount of substance remaining in the syringe is then compared to a rubric to gauge its consistency.

If 1 to 4 mL of the substance remains in the syringe, it is considered of “slightly thick”; 4 to 8 mL remaining is considered “mildly thick”; 8 to 10 mL is “moderately thick” or liquidized; and a substance with 10 mL remaining is “extremely thick” or pureed.

Beyond those categories, food is assessed and labeled as, “liquidized” “pureed” “minced and moist,” “soft and bite-sized” or “regular.” These categories are determined by how the food flows off a spoon or fork, or by measuring a food particle against a ruler.

To implement the program house-wide, the rehabilitation services team partnered with several other departments and disciplines.

Jennifer and Danielle worked with CHOC’s Clinical Nutrition and Lactation department as well as the food service team to create a specific menu for dysphagia patients. It included limited options for each level of consistency and easy-to-follow recipes with three ingredients or less. All food is made from scratch.

The rehabilitation services team developed curriculum for multi-level education of current and new dysphagia therapists, physicians, nursing, dietitians, and food service staff members.

Learn more about rehabilitation services at CHOC.