Aim: Through office-based interventions, we aim to improve the breastfeeding continuation rates of infants at 6 months of age by 10% by June 2020 in a publicly-insured primary care pediatric population. Background: -Breastmilk recommended for infant health. (AAP, 2012 & USDHHS, 2010) -Breastfeeding rate: CPM<South Carolina<US. (CDC, 2018) -Racial disparity in breastfeeding rates nationally. (Louis-Jacques et al, 2017) -Adoption of ABM Clinical Protocol #14 can raise breastfeeding rates in primary care clinics. (Dumphy et al, 2016)
Methods -Chart review of infant WCCs for infant race, nutrition source, lactation consult, breastfeeding plan, and breast pump ownership. -Subjective survey on level of support moms feel. Prompt for help PDSA Breastfeeding Wording change Spanish with questions Nurse education for ethnic interpretation breastfeeding on cycles prompt applicability card return to work Many mothers Nurses not BF rate dropoff Not all nurses fed breastmilk & fluent in @ 1-2 months. Barriers were asking formula, but only Spanish unsure Return to reported one during rooming. discovered how to ask. work? method.
Results and Conclusions -No increase in breastfeeding rate at age 6 months, despite interventions. -87% of survey responders satisfied with breastfeeding support at CPM. -Racial disparities in breastfeeding rates exist at CPM. -Improvement in culturally competent care. -Better data collection methods are now in place.
Next Steps: -“Back-to-Work” informational pamphlet: pumping, storing milk; workplace rights. -Future PDSA cycles: further adoption of steps suggested in Clinical Protocol #14, to make CPM a Breastfeeding-Friendly Physician’s Office. Meeting the Healthy People 2020 breastfeeding goal at CPM will be a long process, and require joint effort of medical, nursing, and support staff.
Contact information: Becky.Roland@PrismaHealth.org
Revisiting Return to Learn Improving the Effectiveness of a Concussion Management Protocol in Greenville County Schools Trey Suhrstedt, MD Mentors: Franklin Sease, MD and Vicki Nelson, MD
Aim/Background • Aim: Enhance the health and education of Greenville county students who have suffered from a concussion by determining the impact of the Return to Learn Protocol (the Protocol), identifying barriers to its implementation, and providing education and guidance to improve its effectiveness • Concussions can interfere with students’ ability to participate in school • The number of concussions is rising • Following a structured, standardized protocol can improve concussion symptoms • Return to learn is a relatively new concept • The Protocol standardizes how students return to school following a concussion, allowing time for adequate rest and appropriate accommodations
Methods Participant selection: • The main target of this project is Greenville County teachers Study design: • An initial survey will be sent to teachers. Afterwards, the will receive a recorded educational presentation and follow-up survey
Results
Conclusion/Next steps • Need more data • Potential for a large impact with further education and guidance • Some ambiguity in results so far • PSDA cycle currently in process due to initial low response rate
Contact Information • Trey.Suhrstedt@prismahealth.org • 864-867-8080
“No Clots for Kids”-House Staff Education for VTE Prophylaxis Protocol Eric Polley, MD, Elizabeth Tyson, MD, Mark Krom, DO
Aim/Background • VTE incidence in pediatric patients has increased over the last two decades by a factor of 10, soaring from 5.3 per 10,000 to 58 per 10,000 • The reason for this increase is multifactorial (indwelling catheter, prolonged immobility, auto inflammatory syndromes, etc.) • AIM : Qualitatively improve the knowledge and comfort of pediatric residents in the Prisma Health Pediatrics residency with using pharmacologic prophylaxis for VTE prevention in at-risk children
Methodology • VTE prophylaxis protocol was developed which will be used to screen patients while in the hospital to determine their risk of developing VTE • I created an educational video to teach VTE incidence, causes, and order set utilization • Pre- and Post-module surveys to assess efficacy of module
Analysis and Results • 20 residents, 5 completed • Q2: On a scale of 1-5, how familiar are you with Prisma • 10 question survey once Health’s new protocol which will be implemented to reduce the incidence of VTE? completed 12.5 10 • Scaling questions (scale of 1-5) 7.5 5 • On the right, 2 selected 2.5 questions from the post-module 0 questionnaire are featured: Pre Module Post Module familiarity with VTE screening • Q9: How likely are you to order anticoagulation and likelihood of ordering for appropriate pediatric patients now that you have completed this module? (Scale of 1-5) prophylaxis 4 3 2 2 1 Post Module
Conclusions and Next Steps • Study was low power (n=5) • The Next Steps of this • Residents who completed module project is to fully integrate had better understanding of VTE risk the module into resident • 80% of residents (4/5) will now onboarding material order VTE prophylaxis appropriately • A long term patient data- • Recommend integration into onboarding for future residents centered retrospective analysis of VTE incidence since implementing educational module
Contact Information • Eric Polley, MD-Resident PGY IV, Internal Medicine/Pediatrics • Prisma Health Upstate • 701 Grove Road, Greenville, SC 29605 • (864) 608-6322
Transition of Autism and Intellectual Disability to Adult Medicine Zachary Wood, Meds Peds PGY-4 Justin Holladay, Meds Peds PGY-4 Nancy Powers, Developmental Behavioral Pediatrics
AIM/BACKGROUND • The purpose of this quality improvement project is to improve the transition of adolescents and young adults with autism and intellectual disability from pediatric to adult providers. • Significant pressure is getting placed on health systems for accommodations of patients with autism and intellectual disabilities. • Currently at Prisma Health Upstate there is no dedicated program in place for adult patients with autism and intellectual disability. PRIVILEGED AND CONFIDENTIAL This document is not subject 20 to discovery pursuant to South Carolina statutes.
METHODS Patient selection: Patient analysis included a chart review of • adolescents and young adults aged 14 and up who currently receive care at the Developmental Behavioral Pediatrics Clinic in Greenville, SC and received care at the clinic from 03/01/2019 to 03/01/2020. Patients were included via an Epic request for charts with a diagnosis of autism spectrum disorder, intellectual disability and/or both . Study design: Data was collected by manual chart review • measuring the current number of patients who have transition discussed in their visits, as well as the average age of transition discussion initiation and presence of successful transition to adult provider . This was done with the goal after our intervention to evaluate the change in both total number as well as time-to-transition initiation at the Developmental Behavioral Pediatrics Clinic. Data Analysis: A sample size of 250 patients were investigated to • identify presence of transition of care discussion. We compiled data regarding the age at initial transition discussion and whether a successful transition to adult provider had taken place . No statistical analysis performed. PRIVILEGED AND CONFIDENTIAL This document is not subject 21 to discovery pursuant to South Carolina statutes.
PRIVILEGED AND CONFIDENTIAL This document is not subject 22 to discovery pursuant to South Carolina statutes.
CONCLUSIONS NEXT STEPS Average transition talk is well behind recommended Assist Prisma Health developmental/behavioral • • age of 14 pediatric professionals with implementing the first phase of building a transition model for youth with ID/DD. Create an EMR tool to include transition of care • discussion into visits starting at age 14. Create an “age of majority” resources for teachers to • use during the IEP process to discuss transition and Almost half of all 18+ patients do not have • dedicated adult providers decision-making authority in a more comprehensive way that points families toward resources that promote independence. Create a webinar that coincides with the “Stop, Look • and Listen” tool to offer additional guidance, resources, and modification ideas to teachers. Create an adapted “Stop, Look and Listen” tool for • medical professionals to use when planning for patient transition from pediatric to adult medical care. Provide training to staff at Prisma Health Greenville on both this tool and other resources that may help them promote independence. PRIVILEGED AND CONFIDENTIAL This document is not subject 23 to discovery pursuant to South Carolina statutes.
CONTACT INFORMATION Zachary Wood, MD Justin Holladay, MD Zachary.Wood@prismahealth.org Justin.Holladay@prismahealth.org PRIVILEGED AND CONFIDENTIAL This document is not subject 24 to discovery pursuant to South Carolina statutes.
“Brr It’s Cold in Here: An Approach to the Hypothermic Infant” • Jennifer Raffaele MD, Grace Williams MD • Elizabeth Tyson MD, Mark Krom DO, James Sierakowski DO
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