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Division of Excellence in Patient Safety & Clinical Quality
The Division of Excellence in Patient Safety and Clinical Quality strives to support the mission of Connecticut Children’s to partner with patients, families and communities using evidence-based models resulting in zero-harm, highest quality, world-class outcomes in a culture based on continual improvement and compassionate care, through the integration of patient safety and quality across the institution. The division’s goal is to drive our culture of safety to the standard of zero-harm, to provide the highest quality care, to teach methods of improvement, and to use research to inform our programmatic efforts and innovations.
The faculty of the Division of Excellence in Patient Safety and Clinical Quality achieved many substantial milestones and accomplishments this year, both despite the unique challenges that the Covid-19 pandemic brought and as a direct result of this impact. Division director Lori Pelletier, PhD, MBA, has been and continues to be a principal co-leader in the response of Connecticut Children’s to the emerging and ongoing pandemic. Dr. Pelletier and members of the division helped to lead the efforts of initial modifications and response to the Covid pandemic, followed by the safe resumption of operations and the planning and operations of the second-wave response. Part of the fundamental framework of this response has been the development of clinical pathways for the multiple phases and aspects of caring for our patients, keeping our team members safe, and providing essential resources and guidance for our community partners. This work has been co-led by division faculty member Ilana Waynik, MD, along with the rest of the Clinical Pathways Team. In recognition of these critical efforts, Dr. Waynik was a co-recipient of the Quality Cup Award from the Medical Staff Office this year, accepting the award with Grace Hong, APRN, another member of the Clinical Pathways Team.
The Simulation Team, under the direction of Carla Pruden, MD, MPH, played a critical role in the design and testing of Covid-related processes, as well as the adaptation for safe conduct of ongoing educational and training curriculum for routine simulation sessions, via virtual and hybrid models. Mariann Kelley, MD, who also supports the Simulation Program, helped to develop and test protocols related to resuscitation and care of critically ill patients with known or concern for Covid-19, in conjunction with the Emergency Response Committee of which she is a co-chair.
The practice changes and diversion of attention to Covid19-related planning led to some concern for increasing patient safety events early in the pandemic. The Safety Taskforce was formed in the spring to address this, co-led by Heather Tory, MD, MPH, with work streams addressing the issues of highest priority and concern. Through the partnerships and work of the task force and team members across the organization, Connecticut Children’s had a robust response to these safety concerns and saw a reduction in safety events with harm throughout 2020. Many division members contributed to the work of this task force and to the commitment of reduction of actual and potential patient safety events, primarily related to medication safety. This included: Daniel Fisher, MD, with his work as a co-chair of the Medication Safety Management Committee to reduce medication safety errors; Sherene Mason, MD, MBA, with ongoing efforts to reduce nephrotoxic-medicationassociated acute kidney injury and ensure highest quality and safest care for the complex patients seen in the new Dialysis Center, which opened in April 2020; Eric Hoppa, MD, who continued work on initiatives to improve medication delivery and safety in the Emergency Department, with publication of two related manuscripts during the year; Natalie Bezler, MD, with implantation of protocols for safely and effectively treating patients with sickle cell pain crisis, including goals for reduction in readmissions for this population; Logan Jerger, MD, working to improve safety of delivery of infusion medications; Jennifer Girotto, PharmD, championing the Antimicrobial Stewardship Program and participating in implementation of changes to ordering practices for antimicrobials in response to multiple safety-eventrelated concerns; and Alex Golden, MD, MMM, working with the Continual Improvement Team to support many of these ongoing efforts. Drs. Tory and Bezler also have continued to lead the resident quality improvement educational curriculum, with incorporation of resident involvement in real-time safety event investigations this year as part of a partnership with the UConn Graduate Medical Education (GME) Office.
Despite the pandemic, Connecticut Children’s has continued to provide exceptional care for all patients, with many quality improvement initiatives led by faculty members of the division. Under the leadership of Brendan Campbell, MD, MPH, we participate in the American College of Surgeons’ National Surgical Quality Improvement Program and the Children’s Surgery Verification Program. These collaborations have resulted in multiple quality improvement initiatives with excellent results, such as work to improve response and outcomes for button battery ingestions, and work on reduction in our rate of hospital acquired conditions such as surgical site infection and central line-associated blood stream infection (CLABSI) rate.
Connecticut Children’s also continued to develop our Care Alliance Partnerships and David Sink, MD, worked to enhance communication and alignment of care practices and quality improvement initiatives across our geographically diverse sites.
The work of the faculty of the Division of Excellence in Patient Safety and Clinical Quality, with multidisciplinary partnership, has been instrumental in the efforts to continue providing highest quality and safest care to our patients throughout the Covid-19 pandemic, and we look forward to ongoing efforts to promote the quality of care for patients throughout the region in the coming year.
PUBLICATIONS
Dulek DE, Fuhlbrigge RC, Tribble AC, Connelly JA, Loi MM, El Chebib H, Chandrakasan S, Otto WR, Diorio C, Keim G, Walkovich K, Jaggi P, Girotto JE, Yarbrough A, Behrens EM, Cron RQ, Bassiri H. Multidisciplinary guidance regarding the use of immunomodulatory therapies for acute Covid-19 in pediatric patients. J Pediatr Infect Dis Soc. 2020 Aug 18: piaa098. doi:10.1093/jpids/piaa098. Epub ahead of print. Kasmire KE, Cerrone C, Hoppa EC. Reducing antibiotic
prescription errors in the emergency department: a quality improvement initiative. Pediatr Qual Saf. 2020; 5(4):1-7.
Lewis E, Waynik I, Mackey S. Decreasing pain experienced by hospitalized pediatric patients by increasing the use of topical anesthetics for peripheral intravenous (PIV) line placement. BMJ Open Qual. Dec 2019; 8(S2)A16-A19; doi:10.1136/bmjoq-2019-ihi.10.
Pelletier L, Johnson S, Strong D, Tulu B, I, Garber L. Applying a standardization lens to enhance electronic health records systems. [conference paper] Proceedings of the 2020 IISE Annual Conference, New Orleans, LA. 2020 Oct 31.
Pruden C, Beecham GB, Waseem M. Human factors in medical simulation. [Updated 2020 Sep 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi. nlm.nih.gov/books/NBK559226/.
Pruden C, Wadhwa R. Medical simulation center director as a system improvement leader. [Updated 2020 Apr 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi. nlm.nih.gov/books/NBK557688/.
Sneller H, Keenan K, Hoppa E. A quality improvement initiative to improve the administration of systemic corticosteroids in the pediatric emergency department. Pediatr Qual Saf. 2020 Jun 8; 5(3):e308. doi: 10.1097/ pq9.0000000000000308. eCollection May-Jun 2020.
Tory HO, Zurakowski D, Kim S. Patient and physician discordance of global disease assessment in juvenile dermatomyositis: findings from the Childhood Arthritis & Rheumatology Research Alliance Legacy Registry. Pediatr Rheumatol. 2020;18(1):5. doi: 10.1186/s12969020-0402-x.
Tribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, Kronman MP, Terrill CM, Sharland M, Newland JG; Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative (Girotto J). Appropriateness of antibiotic prescribing in United States children’s hospitals: a national point prevalence survey. Clin Infect Dis. 2020 Nov 5;71(8):e226-e234. doi: 10.1093/cid/ciaa03.
Doucette ML, Dayton H, Lapidus G, Borrup KT, Campbell BT. Firearms, dementia, and the clinician: development of a safety counseling protocol. J Am Geriatr Soc. 2020 Sep; 68(9):2128-2133.
Duncan TK, Weaver JL, Zakrison TL, Joseph B, Campbell BT, Christmas AB, Stewart RM, Kuhls DA, Bulger EM. Domestic violence and safe storage of firearms in the Covid-19 era. Ann Surg. 2020; 272(2):e55-e57.
Kuhls DA, Falcone RA Jr, Bonne S, Bulger EM, Campbell BT, Cooper Z, Dicker RA, Duncan TK, Kuncir EJ, Lamis DA, Letton RW Jr, Masiakos PT, Stewart RM, Knudson MM. Prevention of firearm injuries: it all begins with a conversation. J Trauma Acute Care Surg. 2020 Feb;88(2):e77-e81.
Campbell BT, Thaker S, Fallat ME, Foley DS, McClure E, Sakran JV, Nasr IW, Ziegfeld S, Ehrlich PF, Snodgrass M, Levy M, Naik-Mathuria BJ, Johnson B, Demello AS, Jones S, Watters JM, Burke P, Allee L, Kozyckyj T, Letton RW, Kuhls DA, Bulger EM, Stewart RM. A multicenter evaluation of a firearm safety intervention in the pediatric outpatient setting. J Pediatr Surg. 2020 Jan;55(1):140-145.
Hagadorn JI, Johnson KR, Hill D, Sink DW. Improving the quality of quality metrics in neonatology. Semin Perinatol. 2020;44(4):151244. doi:10.1016/j. semperi.2020.151244. PMID: 32248956.
STAFF
Lori Pelletier, PhD, MBA, Division Director Natalie Bezler, MD Brendan Campbell, MD, MPH Daniel Fisher, MD Jennifer Girotto, PharmD Alex Golden, MD, MMM Eric Hoppa, MD Logan Jerger, MD Mariann Kelley, MD Sherene Mason, MD, MBA Carla Pruden, MD, MPH David Sink, MD Heather Tory, MD, MPH Ilana Waynik, MD
