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Patient Safety/Quality ImprovementResearch Grant Program

Developed by the WUSM Faculty Practice Plan with Partial Financial Support from the BJH Foundation

February 17, 2015

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Patient Safety Investments at WUSM

In 2008 the FPP Professional Liability Committee set aside a portion of the savings from the professional liability refunds to support patient safety initiatives

The FPP and clinical departments have made investments to support patient safety, including:

Co-funding with departments Patient Safety Coordinators to support faculty members designated to serve as Patient Safety Officers. This support has allowed these departments to expand their patient safety efforts

Advanced training for these and other faculty in patient safety and quality improvement techniques through the Institute of Healthcare Improvement (IHI)

Two major initiatives in simulation team training: Emergency Medicine (high volume/high impact and rare events); and OB emergencies (decision to incision)

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In October 2013, the FPP PLC approved the use of $250,000 from the 2008 professional liability set aside fund to establish a new Patient Safety/Quality Improvement Research Grant Program

These funds were subsequently matched by the BJH Foundation creating a total funding pool of $500,000

In 2014 ICTS was engaged to administer the grant process in partnership with FPP Patient Safety

Patient Safety & Quality Improvement Research Grant Program

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WUSM PS/QI Research Grant

GoalThe goal of the Patient Safety & Quality Improvement Research Grant Program is to provide financial support for patient safety and quality improvement initiatives

FocusInnovative interventions and models of care that have the potential to improve patient safety, safety culture or quality of care

Early phase projects that provide preliminary data needed to attract future funding are encouraged

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Measuring harm Understanding causes of harm Process improvement measures Innovative implementation strategies for sustainability of improvement measures Safety culture and its impact on harm Electronic tools to maximize improvements Studies related to complex, multi-disciplinary or multi-specialty teamwork issues

(physician handoffs, consults, etc.) Continuum of care and ambulatory patient safety Patient Safety in prevention of diagnostic adverse events

WUSM PS/QI Research Grant

Examples of projects that meet the RFA objectives include, but are not limited to:

Funds available: Up to $50,000/year with possibility of second year

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Application Process One application/ per investigator Support letter from Chair 43 LOIs reviewed by a sub-group of experienced WUSM Departmental Patient Safety

Officers PSO 34 investigators were invited to submit full proposals

Study Section Each full proposal was assigned to 2 experienced scientific reviewers They were then evaluated in a full review panel composed of 24 WUSM, BJH and

SLCH representatives The review session was conducted similar to an NIH Study Section using the 9-point

scale

WUSM PS/QI Grant

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Timeline September 2014: Call for proposals sent to WUSM clinical faculty

43 LOIs received

December 2014: Study section convened to review and rank 34 proposals meeting the grant program eligibility criteria

January 2015: 6 proposals representing a diverse group of investigators were approved for funding

February 9, 2015: Grant awardees notified. Just in Time process begun.

April 2015: Award funds will be released

September 2015: Six-month progress reports due

June 2016: Patient Safety/Quality Improvement Grantee Symposium

Patient Safety & Quality Improvement Research Grant Program

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2015 WUSM PS/QI Grant Recipients

Elna Nagasako Medicine Creation of a hospital discharge summary tracking system for community health center patients

Andrea Vannucci Anesthesiology Electronic Capture of Airway-related adverse events in adult general anesthesia

Rakesh Rao Pediatrics Ensuring safe perioperative handoffs

Ronald Jackups, Jr. Pathology & Immunology

Development of Clinical Decision Support Tools for Patient Blood Management

Garry Tobin Medicine Identify, Analyze and Improve systems for patients at risk for Severe Hyperglycemia at BJH

David Limbrick Neurological Surgery

Management of Children with Traumatic Brain Injury After Head CT

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Creation of a Hospital Discharge Summary Tracking System for Community Health Center Patients

Elna Nagasako—Medicine

The handoff from hospital providers to providers in the community is the foundation for safe transitions of care for patients traversing the inpatient and outpatient settings. There is currently no robust tracking system to verify that discharge summaries reach community health center primary care providers. In response to results from a 2014 survey of community health center primary care providers describing gaps in provider communication at hospital discharge, this project seeks to evaluate and improve discharge summary transmission from inpatient WUSM faculty at Barnes-Jewish Hospital to community health center providers by creating a hospital discharge summary tracking system in collaboration with the St. Louis Integrated Health Network. This project will 1) audit the current rates of discharge summary transmission to community health center providers and 2) construct and evaluate a sustainable robust real-time method for monitoring discharge summary receipt.

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Electronic Capture of Airway-Related Adverse Events in Adult General Anesthesia

Andrea Vannucci—Anesthesiology

Unplanned re-intubation and delayed extubation after general anesthesia are significant adverse events associated with escalations of care, untoward patient outcomes, and increased costs. The recognized risk factors for these events are patient co-morbidities and side effects of surgery and anesthesia. This study will focus on anesthesia-related complications. We aim to assess the incidence of early re-intubation and delayed extubation in a general patient population and to identify the role of potential risk factors such as the intraoperative use of specific anesthetic drugs and intravenous fluids (considering their doses and administration times in relation to the unfolding of surgery), and mechanical ventilation’s modalities.

The main goal is to identify modifiable patterns of practice associated with these complications that can be the object of patient safety interventions. The secondary aim is to develop and validate a new search strategy for adverse events based on querying data automatically stored in the anesthetic electronic record.

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Ensuring Safe Perioperative Hand-offsRakesh Rao—Pediatrics

Critically ill newborn infants in the Neonatal Intensive care unit (NICU) often require surgical interventions that vary from establishment of vascular access to exploratory laparotomy or closure of abdominal wall defects. These procedures involve multiple providers and disciplines including surgery, anesthesiology, and neonatology. In this high risk population and complex environment, ensuring that care is transitioned between different providers safely and effectively in a timely manner is critical for improving patient safety through prevention of medical errors.

As part of a national consortium, we have established a structured and standardized hand-off process for transfer of care from the anesthesia to the NICU team in the post-operative period in order to improve perioperative hand-off processes, improve patient safety and minimize adverse events. We propose to develop similar processes for hand-offs in the pre-operative phase, transition this information to electronic format for easy availability and retrieval to improve patient safety and outcomes.

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Development of Clinical Decision Support Tools for Patient Blood Management

Ronald Jackups, Jr—Pathology & Immunology

Transfusion is a life-saving medical procedure used in many clinical situations, but has recently been associated with overuse and life-threatening complications. Clinical decision support (CDS), including the use of interruptive alerts at the time of transfusion order entry, has been used to educate clinicians and prevent inappropriate transfusion, but existing tools are rudimentary, relying on non-specific triggers such as laboratory values (hemoglobin concentration), resulting in suboptimal reduction of inappropriate transfusion.

We plan to extract and analyze multiple variables from several hundred thousand transfusion events at two BJC hospitals in order to design formulas to more accurately predict the risk of inappropriate transfusion. We then plan to incorporate these formulas into sophisticated CDS alert systems to minimize inappropriate transfusion, and will iteratively optimize the alerts throughtout the study to meet this goal.

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Identify, Analyze & Improve Systems for Patients at Risk for Severe HyperglycemiaGarry Tobin-Medicine

Strategies for a hospital-wide and system-wide glucose control effort to prevent and treat severe hypoglycemia were successfully addressed and implemented by our WU/BJH diabetes team in 2011-12.

Our diabetes team plans to use a similar process to address severe hyperglycemia at BJH. We further plan to recommend clinical change - persuading WU/BJH practitioners regardless of discipline to know and understand the standards of care for inpatients with diabetes.

Our aims are to assess staff knowledge and competencies, enhance competencies, provide education, develop/share de-identified case-based curriculum based on data analysis of 50 severe hyperglycemia events at BJH.

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Management of Children with Traumatic Brain Injury After Head CTDavid Limbrick—Neurosurgery

Traumatic brain injury (TBI) is among the most common and most harmful pediatric health problems in the United States. Most children experience mild TBI (mTBI), which is responsible for one-third of the 50,000-60,000 annual pediatric TBI hospital admissions.

While substantial resources have been invested to determine which children with mTBI require head CT, how CT findings, how this should be integrated with other clinical information to guide safe and efficient management practices remains unclear. To address this uncertainty, this study will: 1) utilize a large multicenter dataset to determine the appropriate level of care for children with mTBI following head CT; and 2) develop a survey to assess influences on physician decision-making and barriers to evidence-based practices in the management of children with mTBI after head CT.

This study will significantly advance the evidence-based management of children with mTBI and will set the stage for future implementation research in this important field.

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