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Quality

Golisano Children's Hospital / Quality / Scholarly Works

Scholarly Works - Quality Improvement Studies

We conduct studies on behalf of our commitment to quality and safety improvements at Golisano Children's Hospital (GCH), in Rochester, NY. Read about some of our most recent endeavors.

Decreasing Use of Sedation and Anesthesia for Pediatric Gastrojejunostomy (GJ) Tube Exchanges

GJ Express: An Improvement Initiative to Decrease Sedation and Anesthesia for Gastrojejunostomy Tube Exchanges

GJ Express: an improvement initiative to decrease sedation and anesthesia for gastrojejunostomy tube exchanges. Cheng QE, Schriefer J, Sosa T, Haen S, Ferguson S, Clark A, Boerman C, Hochreiter, C, Gabel ME, Young A, Lee DE, Ackerman KG. (204) Pediatric Research, published online February 22,2024. doi: 10.1038/s41390-024-03070-1.

  • Why is this measure important? – Our organization works to safely reduce use of sedation and anesthesia in developing children.
  • How we measure? – We used our electronic medical record to track use of sedation and anesthesia for child having GJ tube exchanges.
  • What are we doing to improve? – We developed a program with our Imaging Advanced Nurse Practice provider and Child Life Specialists to support children during the procedure.

Preventing Post-Operative Reintubations in the NICU

A Children’s Surgery Quality Improvement Project

Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement Project. Juviler P, Meyers JM, Levatino E, Axford J, Barker E, Correll L, Decker AS, Faria J, Gloff M, Loria A, McKenna M, Schriefer J, Stevens TP, Verna S, Wegman S, Wolcott K, Wakeman D (2024). Reducing Unplanned Intubations in the Neonatal Intensive Care Unit after Children’s Surgery: A Quality Improvement Project. 2023. Journal of Pediatric Surgery. 59(1): 45-52.

  • Why is this measure important? – Our organization works to prevent harm associated with post-operative unplanned re-intubation.
  • How we measure? – We use our American College of Surgeons National Surgical Quality Improvement Program dataset to track reintubations.
  • What are we doing to improve? – We have developed a post-operative checklist to ensure the team minimizes medications associated with reintubation.

Working to Standardize Central Line Care in the Community

Reducing Community Associated Central Line Associated Blood Stream Infections

An Interprofessional Quality Improvement Project to Reduce Community-Acquired Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population. Neumeister S, Gabel M, Meyers J, Tesini B, Gottfried JA, Fairchild A, Schriefer J. (2023). An Interprofessional Quality Improvement Project to Reduce Community Acquired Central Line Associated Bloodstream Infections in the Pediatric Intestinal Failure Population. The Journal of the Association for Vascular Access. 28(4): 14-22.

  • Why is this measure important? – Our organization works to prevent central line infections that occur in the community not just in the hospital.
  • How we measure? – We use our positive blood culture reports to identify infections and work closely with our infection prevention team.
  • What are we doing to improve? – We have developed a comprehensive program to support families as they care for central lines at home.

Keeping Inpatient Care Teams Safe

Mitigating Pediatric Inpatient Aggression

Mitigating Pediatric Inpatient Aggression: A Quality Improvement Initiative. Keller AR, Kanaley RL, Starr T, Strollo B, Scharf M, Massachi S, Angell L, Clough CD, Schriefer J. (2022) Hospital Pediatrics 2022 May 1; 12(5):499-506.

  • Why is this measure important? – Our organization works to prevent harm to our care teams when patients become aggressive toward the staff and providers.
  • How we measure? – We use our event reporting system and workplace safety reporting systems to track and trend staff safety.
  • What are we doing to improve? – We have developed a comprehensive program that includes training, environmental changes and safety supply enhancements.

Patient and Family Experience

Improving the Timing of Laboratory Studies in Hospitalized Children: A Quality Improvement Study

Improving the Timing of Laboratory Studies in Hospitalized Children: A Quality Improvement Study. Suzanne N. Ramazani, Julie Albright Gottfried, Maha Kaissi, Justin Lynn, Michael S. Leonard, Jan Schriefer and Nathaniel D. Bayer; on behalf of the UR Medicine GCH PHM QI Team. Hospital Pediatrics July 2021, 11 (7) 670-678.

Improving Hospitalized Patient Sleep: It Is Easier Than It Seems

Lauren M. McDaniel. Improving Hospitalized Patient Sleep: It Is Easier Than It Seems. Hospital Pediatrics July 2021, 11 (7) e115-e116.

The Value of Family Advisors as Coleaders in Pediatric Quality Improvement Efforts: A Qualitative Theme Analysis

The Value of Family Advisors as Coleaders in Pediatric Quality Improvement Efforts: A Qualitative Theme Analysis. Suzanne Ramazani, Nathaniel D Bayer, Julie Albright Gottfried, Jenna Wagner, Michael S Leonard, Justin Lynn, Jan Schriefer. Journal of Patient Experience. 2020 Dec;7(6):1708-1714. Epub 2020 Jul 10.

  • Why is this measure important? – Patient and family experience are very important. GCH is involving family advisors as co-leaders of our Quality Improvement teams.
  • How we measure? – GCH uses the Institute of Patient and Family Center Care (IPFCC) framework to ensure family advisors are welcomed on our QI teams.
  • What we are doing to improve? – GCH created the Family Connections program to expand family leaders on our teams.

For more information:

Prevention of SSI

Implementation of a Pediatric Orthopaedic Bundle to Reduce Surgical Site Infections

Implementation of a Pediatric Orthopaedic Bundle to Reduce Surgical Site Infections. Schriefer, Jan; Sanders, James; Michels, Julie; Wolcott, Kori; Ruddy, Connor; Hanson, Jenna. Orthopaedic Nursing: January/February 2017 - Volume 36 - Issue 1 - p 49-59. doi: 10.1097/NOR.0000000000000312

  • Why this measure important – SSI is a preventable post-operative complication. GCH used SSI prevention bundles to prevent infections
  • How we measure – GCH reviews compliance to all elements of the SSI prevention bundles. The compliance is reviewed at monthly surgical QI teams
  • What we are doing to improve – GCH implements rapid cycles tests of change or plan do study act (PDSA) cycles for areas in need of improvements.

Preventing Adverse Drug Events (ADE)

A Quality Improvement Initiative to Optimize Antibiotic Use in a Level 4 NICU

A Quality Improvement Initiative to Optimize Antibiotic Use in a Level 4 NICU. Jeffrey M Meyers, Jamey Tulloch, Kristen Connors, Mary T Caserta, Carl T D'Angio, Golisano Children’s Hospital NICU Antibiotic Stewardship Team. Pediatrics. 2020 Nov;146(5):e20193956. doi: 10.1542/peds.2019-3956. Epub 2020 Oct 14.

  • Why is this measure important? – Antibiotics are medications that can be associated with adverse drug events. Avoiding unnecessary use of antibiotics is important for optimizing infant health and safety.
  • How we measure? – GCH uses standardized tools to assess sepsis risk and we also measure the use of antibiotics to ensure optimize use of the medication.
  • What we are doing to improve? – GCH uses reporting to review antibiotic use across our care teams including physicians and nurse practitioners, nurses and pharmacists.

For more information:

Prevention of Readmissions and Emergency Department Revisits

Implementation of a Gastrostomy Care Bundle Reduces Dislodgements and Length of Stay

Implementation of a gastrostomy care bundle reduces dislodgements and length of stay. Rufolo LI, Palhamus M, Fioto T, Levitino E, Michels J, Schriefer J, Wolcott K, Wakeman D. Journal of Pediatric Surgery. October 12, 2020.

  • Why is this measure important? – Readmission to the hospital and returns to the emergency department is a stressful experience for children. Some readmissions are preventable.
  • How we measure? – GCH uses a process to review readmissions and returns to the emergency department to see if the event could have been prevented.
  • What we are doing to improve? – GCH created a process to contact families following a readmission or emergency department visit to see if there was anything we could have done to prevent the event.

For more information: Visit Patient & Family Education: GCH - G-Tube Home Care

A Quality Improvement Approach to Decreasing Postdischarge Acute Care Reuse Among Children With Asthma

A Quality Improvement Approach to Decreasing Postdischarge Acute Care Reuse Among Children With Asthma. Bracken AE, Fable JM, Lin H, Schriefer J, Voter K, Philip S, Solan LG, Davis C, Shipley LJ, Barker E, Roberts A, Angell L, Flannery M, Muoio E, Noble M, Frey SM. (2020) Title. Hosp Pediatrl. May, 2021. 10.1542/hpeds.2020-002824. Epub 2021 Apr 6. PMID: 33824192.

  • Why is this measure important? – We want to reduce 7-day acute care reuse among children with asthma after discharge from an academic children’s hospital by standardizing the delivery of clinical care and patient education.
  • How we measure? – The mean 7-day reuse rate for asthma after discharge was 3.7% during the 6 months baseline period (n = 107) and 1.0% during the 15-month intervention period (n = 302). This included a shift in our median from 3.3% to 0% with an 8-month period of no 7-day reuse.
  • What we are doing to improve? – Implement interventions designed to improve admission, inpatient care, and discharge processes for children hospitalized because of asthma and including a focus on (1) resident education, (2) patient access to medication and asthma education, and (3) gaps in existing asthma clinical care pathways in the ED and ICU.

A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns. Andrew M. Dylag, Jamey Tulloch, Karen E. Paul, and Jeffrey M. Meyers. Children April, 2021, 8, 301. https://doi.org/10.3390/children8040301

  • Why is this measure important? – A quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%.
  • How we measure? – We focus on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time.
  • Our results – The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Strategic Planning and Quality Improvement

A Proposed Technique to Enhance Strategic Plan Implementation Using Continuous Quality Improvement Methodologies

A Proposed Technique to Enhance Strategic Plan Implementation Using Continuous Quality Improvement Methodologies.
Patrick D. Brophy, Katy Stevenson, Jeffrey Kaczorowski, Jan Schriefer. The Journal of Pediatrics. Volume 224, 2020.

  • Why is this measure important? – Strategic plans for health care organizations are important to our mission of helping every child reach their fullest potential.
  • How we measure? – GCH uses an innovative approach to review deliverables and metrics for each of our goal areas of patient care, community, population health, research, education digital health and culture.
  • What we are doing to improve? – GCH has an interdisciplinary teams that review each of our goal areas in our strategic plan.

For more information:

Pediatric Perioperative Surgical Home

Building a Pediatric Perioperative Surgical Home – One Patient, One Team

Building a Pediatric Perioperative Surgical Home – One Patient, One Team. Robinson, Renee MSN, FNP-BC; Schriefer, Jan MSN, MBA, DrPH; Gloff, Marjorie MD; Michels, Julie MS, RN-BC; Webber, Audra MD; Hilt, Suzanne MSN, PNP-BC; Sanders, James MD; Herman, Emily MSN, PNP-BC. Journal of Pediatric Surgical Nursing: 4/6 2018 - Volume 7 - Issue 2 - p 49-59.

  • Why is this measure important? – Preparing patients for surgery is extremely important. The areas for review include nutrition and lung health.
  • How we measure? – GCH uses a database to review outcomes such as length of stay, readmissions after the surgery and infections related to the surgery.
  • What we are doing to improve? – GCH has an interdisciplinary team that reviews cases before the patient’s procedure and later reviews the outcomes of care following the surgery.

Sleep Safety

An Interprofessional, Multimodal, Family-Centered Quality Improvement Project for Sleep Safety of Hospitalized Infants

An Interprofessional, Multimodal, Family-Centered Quality Improvement Project for Sleep Safety of Hospitalized Infants. Erlick M, Fioravanti ID, Yaeger J, Studwell S, Schriefer J. Journal of Patient Experience. January 2021.

  • Why is this measure important? – It is difficult to create clear consistent communication about sleep safety between health care providers and families during an infant’s inpatient stay.
  • How we measure? – Five family-centered interventions were designed: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a Kamishibai card audit system, and electronic health record smart phrases.
  • What we are doing to improve? – Our coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.