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Yale New Haven Children’s Hospital has celebrated some major successes in the detection and early treatment of a potentially deadly foe: sepsis.
YNHCH joined the national Children’s Hospital Association’s Improving Pediatric Sepsis Outcomes collaborative in 2016. Since then, nurses have collaborated with physicians and staff from Pharmacy, Infection Prevention, Information Technology Services and YNHCH Quality and Safety to redesign care for patients with suspected sepsis.
These interdisciplinary teams developed and implemented measures such as an Epic alert that signals when a patient has sepsis signs or symptoms; order sets for patients with severe and non-severe sepsis; pre-selected antibiotic treatment regimens; and a dashboard that tracks how quickly sepsis patients are recognized and treated.
Results include an 18 percent increase in recognizing sepsis patients; 10 percent decrease in the amount of time it takes to begin intravenous antibiotic treatment and 6 percent decrease in the number of days patients are hospitalized due to sepsis.
The American Academy of Pediatrics (AAP) recommends more frequent primary care visits for youth in foster care, who are at increased risk for adverse health outcomes. Frequent visits help providers stay abreast of their patients’ social situations, identify emerging needs, make timely referrals and offer stable support for their vulnerable patients and families.
In response, YNHH nurses led a quality improvement project at three pediatric sites to help providers comply with AAP guidelines. The project aimed to improve identification of patients in foster care and increase the frequency of primary care visits for these children.
After a patient was seen in the hospital’s Foster Care Clinic, the nurse practitioner routed charts to the child’s primary care providers and sent direct messages (via our electronic health record) with the date of foster placement. AAP guidelines were also included in each patient’s progress note and reports submitted to foster patients’ social workers. Weekly chart reviews were conducted and recorded in a chart listing completed visits.
The collaborative efforts of the Foster Care Clinic and pediatric primary care sites significantly improved primary care follow-up rates for those in foster care. The quality improvement project provided a basis for organizational guidelines for foster patient care. YNHH’s successful efforts can serve as an example for statewide and national foster care health policy reform.
Nurses from YNHH’s Saint Raphael Campus Surgical Step-down unit conducted a study, The Effect of Teaching Important Medication Effects (TIME) Intervention on Medical-Surgical Patients. Results showed that when nurses used TIME, a medication teach-back method, patients were much more likely to recall medication side effects at discharge and 48 to 72 hours after. Patients also reported that nurses “always” told them why they were on a new medication and explained side effects, and were very satisfied with their nurses’ medication teaching. The unit experienced a dramatic and sustained improvement in HCHAPs patient satisfaction scores related to medication communication since initiation of the TIME intervention.
