Publications by authors named "Cassandra Pruitt"

3 Publications

  • Page 1 of 1

Quality Improvement Initiative to Increase the Use of Nasogastric Hydration in Infants With Bronchiolitis.

Hosp Pediatr 2017 08 5;7(8):436-443. Epub 2017 Jul 5.

Department of Pediatrics, Washington University, St Louis, Missouri.

Background And Objectives: Intravenous (IV) hydration is used primarily in children with bronchiolitis at our institution. Because nasogastric (NG) hydration can provide better nutrition, the goal of our quality improvement (QI) initiative was to increase the rate of NG hydration in eligible children 1 to 23 months old with bronchiolitis by 20% over 6 months.

Methods: We used Plan-Do-Study-Act cycles to increase the use of NG hydration in eligible children. Interventions included educational and system-based changes and sharing parental feedback with providers. Chart reviews were performed to identify the rates of NG hydration, which were plotted over time in a statistical process control p chart. The balancing measure was the rate of complications in children with NG versus IV hydration.

Results: Two hundred and ninety-three children who were hospitalized with bronchiolitis needed supplemental hydration during the QI initiative (January 2016-April 2016). Ninety-one children were candidates for NG hydration, and 53 (58%) received NG hydration. The rates of NG hydration increased from a baseline of 0% pre-QI bronchiolitis season (January 2015-April 2015) to 58% during the initiative. There was no aspiration and no accidental placement of the NG tube into a child's airway. Nine patients (17%) in the NG group had a progression of disease requiring nil per os status, and 6 of these were transferred to the PICU whereas none of those in the IV group were transferred to the PICU. Post-QI initiative, the majority of nurses (63%) and physicians (95%) stated that they are more likely to consider NG hydration in children with bronchiolitis.

Conclusions: We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions.
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August 2017

Development of a pediatric hospitalist curriculum to promote faculty development, teaching excellence, and evidence-based care.

Hosp Pediatr 2014 Nov;4(6):387-92

Department of Pediatrics, Washington School of Medicine, Saint Louis, Missouri; and.

Objective: The Pediatric Hospital Medicine Core Competencies (PHMCC), published in 2010, serve as the foundation for development of pediatric hospital medicine curricula to standardize and improve inpatient pediatric training and practice. Here the authors describe development of a PHMCC-based curriculum for faculty development, improved teaching, and evidence-based care, and as the basis for scholarly projects.

Methods: A 2-year repeating curriculum of 51 topics based on the PHMCC was designed, presented by hospitalists for division members at weekly division conferences, and recorded for asynchronous learning. Fourteen of those topics were created for online viewing only. Topic development included use of pertinent medical research, guidelines, and local experts. Presentations followed a standardized format and were reviewed by senior division members before delivery. Attendees evaluated all presentations.

Results: Twenty live topics were presented. All talks received ratings of 4.3 or higher (on a scale of 1 to 5) on evaluation by attendees, and 70% of presentations were reported as likely to change practice by 80% or more of attendees. Opportunities for increased mentorship were realized. The division was recognized for its work through an invitation to present topics 4 times annually at a community-wide continuing medical education program and regional pediatric meetings, and proposals have been submitted for national meetings.

Conclusions: The PHMCC-based curriculum has led to increased opportunities for education, mentorship, and improvement in the quality of care by attendees. Other academic divisions may benefit from a curriculum to enhance professional development and standardize clinical care and teaching.
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November 2014

Development of performance tracking for a pediatric hospitalist division.

Hosp Pediatr 2013 Apr;3(2):118-28

Washington University, St Louis School of Medicine, Department of Pediatrics, Division of Hospitalist Medicine, St Louis, Missouri 63110, USA.

Objectives: Our goal was to develop a comprehensive performance tracking process for a large pediatric hospitalist division. We aimed to use established dimensions and theory of health care quality to identify measures relevant to common inpatient diagnoses, reflective of current standards of clinical care, and applicable to individual physician performance. We also sought to implement a reproducible data collection strategy that minimizes manual data collection and measurement bias.

Methods: Washington University Division of Pediatric Hospital Medicine provides clinical care in 17 units within 3 different hospitals. Hospitalist services were grouped into 5 areas, and a task group was created of divisional leaders representing clinical services. The group was educated on the health care quality theory and tasked to search clinical practice standards and quality resources. The groups proposed a broad spectrum of performance questions that were screened for electronic data availability and modified into measurable formulas.

Results: Eighty-seven performance questions were identified and analyzed for their alignment with known clinical guidelines and value in measuring performance. Questions were distributed across quality domains, with most addressing safety. They reflected structure, outcome, and, most commonly, process. Forty-seven questions were disease specific, and 79 questions reflected individual physician performance; 52 questions had electronically available data.

Conclusions: We describe a systematic approach to the development of performance indicators for a pediatric hospitalist division that can be used to measure performance on a division and physician level. We outline steps to develop a broad-spectrum quality tracking process to standardize clinical care and build invaluable resources for quality improvement research.
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April 2013