Building the Future Together
2017 Patient Services Annual Report
2017 Patient Services Annual Report
Building the Future Together
Welcome 2 Run, dance, bike!
3
Meet the Reading and Literacy Discovery Center
5
Designing the Future of Healthcare
7
Employees Drive the Future: Critical Care Building Planning
11
One Admission Process: Reducing the Burden of Documentation
15
Looking Out for Our Community
17
Speech-Language Pathology’s STAR Feature Patient: Kaleb
19
Patient Services Awards
21
Optimal Outcomes
23
Nursing Continuing Education
25
Research in Patient Services
27
Nursing Certifications
28
1
2017 PATIENT SERVICES ANNUAL REPORT
Colleagues, Friends and Child Health Champions, The rich history of Cincinnati Children’s is at the core of the Department of Patient Services. We know that the groundbreaking work of our founders set the institution on the path for international stature. As one of the largest, most respected children’s hospitals in the United States today, we continue to honor our past … by planning for the future. Much of this happens organically because of our exceptional, forward-thinking staff in Patient Services. Our employees see the bigger picture. They know the future is built with patients, families and the community. In this annual report you will see that mindset exemplified through partnerships to promote wellness in children with developmental disabilities; a new literacy center; a social services role dedicated to community health; a smoother admission process; innovations in speech-language pathology and anesthesia; and perhaps the most publicized story, the construct of a new critical care tower, which was shaped by the voice of our clinicians. We know that building the future only happens interprofessionally and through collaboration. And it takes a team with top-notch expertise, which is exactly what we have in Patient Services.
Our employees see the bigger picture. They know the future is built with patients, families and the community.
Sincerely,
Cheryl Hoying PhD, RN, NEA-BC, FACHE, FAAN Senior Vice President of Patient Services
2017 PATIENT SERVICES ANNUAL REPORT
2
Run, Dance, Bike! Community collaboration enhances wellness and participation in Children and adolescents with developmental disabilities. The World Health Organization recommends that children engage in at least 60 minutes of moderate to vigorous physical activity daily. Unfortunately, children with physical disabilities demonstrate 30% lower physical activity levels than public health guidelines recommend and spend double the amount of time in sedentary behavior relative to typically developing peers. The expectation of Occupational Therapists and Physical Therapists has evolved to include health promotion. There are many barriers to daily physical activity cited by children and families with developmental disabilities, including negative societal attitudes and the absence of opportunities to play among similarly-abled peers. Through community wellness programs, these barriers to physical activity can be overcome. 3
2017 PATIENT SERVICES ANNUAL REPORT
Fueled by their own passion for participation in physical activity, therapists in the Division of Occupational Therapy and Physical Therapy have partnered with community agencies to develop community wellness programs for children and adolescents with developmental disabilities. Programs occur in natural settings, are supported by volunteer infrastructures, and have been implemented at no or limited cost to families. This is due in large part to grants and private donors such as the Convalescent Hospital Association of Volunteers, a CCTST Community Health grant, the Cooperative Society, 50 West Cycling Company, Woodward Technical High School, Social Venture Partners, the Jack H. Rubinstein Foundation, and Mr. and Mrs. Tomas G. Cody.
Be Well Running Be Well Running emerged out of frustration reported by a child with hemiplegic cerebral palsy during a running test in physical education class. Jen Angeli, DPT, PhD, partnered with local agencies to generate a 10-week, “Sit to Fit� training program, which includes bi-weekly group runs and culminates in the completion of a 5K race. Running participants have demonstrated a significant increase in number of steps per day and gains in submaximal cardiorespiratory endurance. They have also demonstrated gains in quality of life metrics like global self-worth. More than 40 runners have now crossed a finish line.
Ballet Moves Ballet Moves is the product of a collaborative effort between Julie Sunderland, Director of Education for Cincinnati Ballet, Michelle McGuire, PT, and a request for a curriculum for children with Down syndrome. Weekly dance classes are offered each fall and spring and, due to the program’s success, Ballet Moves has expanded to include children with cerebral palsy. Dancers have demonstrated improvement in balance and gross motor abilities, and improved social interaction skills. One parent reports, “it was a great experience for her to be with a true group of her peers in an active and social setting.” One Ballet Moves dancer, Jack Barlow, performed in last season’s Cincinnati Ballet performance of The Nutcracker.
Be Well Bike Be Well Bike was developed in response to a large analysis of patient-identified goals and recognition that bicycle riding is a highly prioritized area not well served by existing therapy models. Through a partnership with iCanShine and a proprietary fleet of training bicycles, more than 70 participants have completed a week-long bicycling boot camp. Eighty percent of those participants have concluded the experience as independent riders on non-adapted, two-wheeled bicycles. It has been described as a “program that works miracles”.
2017 PATIENT SERVICES ANNUAL REPORT
4
COMMUNICATION SCIENCES RESEARCH CENTER
Communication Sciences Research Center
Meet the Reading and Literacy Discovery Center Alongside walking, talking, and socialization, a critical developmental milestone for children is learning to read. The American Academy of Pediatrics (AAP) recommends literacy promotion in primary care beginning at birth, citing enduring cognitive, social-emotional, and neurobiological benefits that strongly influence health outcomes. Cincinnati Children’s sets reading proficiency as an institutional goal and highlights it in their SP20 Plan. The Reading & Literacy Discovery Center (RLDC) at Cincinnati Children’s is committed to reinforcing this perspective of reading as a vital public health issue. The Center’s mission is to enable every child to discover the joy and empowerment of reading through the application of innovative research and community partnerships.
5
2017 PATIENT SERVICES ANNUAL REPORT
Because reading was developed less than 6,000 years ago, there is no brain network dedicated to this skill. Instead, networks for vision, language, and executive functions are gradually integrated during childhood, guided by home and educational environments. While often miraculous, this process can go awry in different ways, resulting in reading difficulties affecting approximately 40% of the United States population. The RLDC is a
unique team made up of pediatricians, researchers, speech pathologists, and reading specialists. They seek to address the reading crisis through evidence-based screening, prevention, early intervention, and remediation. Research is the foundation for RLDC and, thanks to unique resources available at Cincinnati Children’s, 2017 has been a productive year. Dr. Tzipi Horowitz-Kraus is the Scientific Director
at the RLDC and a world leader in the evaluation and treatment of dyslexia. Her most recent study was launched to validate the role of executive functions in reading development and serve as a therapeutic target for children with dyslexia, areas in which she is a pioneer. She has published numerous MRI-based studies exploring the influence of family history and other factors on neural biomarkers of reading difficulties, and also developed a rapid screening tool for children aged 6-14. Prevention is also a focus of the Center. Dr. John Hutton, the community director of RLDC, has published the first studies showing how home reading environment and parent-child reading practices affect the developing brain prior to kindergarten. Dr. Hutton is also a prolific children’s book author, and recently published a special type of children’s book called Sleep Baby Safe and Snug, for safe sleep education and SIDS prevention. A randomized trial led by Dr. Hutton showed this book was
superior to brochures for increasing adherence to American Academy of Pediatrics guidelines and reducing SIDS risk. Dr. Hutton is developing a portal-based approach to screening early literacy skills and risk factors during pediatric well-child visits. That includes screen-based media use, which he plans to validate in a major longitudinal study.
divisions within CCHMC, to develop innovative, efficient strategies for literacy and health literacy promotion. Dr. David Moore, recently appointed as RLDC’s new director, has research interests in the relation between childhood hearing and learning problems, including dyslexia. This will open a new collaborative research area for RLDC.
Launched in 2016, the RLDC clinical program has grown rapidly. It provides evaluations at three Cincinnati Children’s locations to children between 6 years old and eighth grade who have suspected reading difficulties, and they have plans to expand. The comprehensive set of tests helps determine a child’s specific strengths and weaknesses in the context of medical and family history, and provides an accurate diagnosis and targeted recommendations for working with the child at home and in school. RLDC is also pursuing clinical partnerships with schools, community groups, and
RLDC maintains a website where parents and educators can find evidence-based information about reading, dyslexia, and literacy programs (https://rldc. cchmc.org; 513-803-READ).
40% of the
US population has reading difficulties
2017 PATIENT SERVICES ANNUAL REPORT
6
COMMUNICATION SCIENCES RESEARCH CENTER
Designing the Future of Healthcare Nurses at Cincinnati Children’s go the extra mile to bring their innovations to life. Cincinnati Children’s knows that collaboration is a key component to encouraging innovation. This includes multidisciplinary collaboration within the organization, inclusion of patients and families, and strategic use of experts in the local and global community. With a strong history of partnership with University of Cincinnati Health, Cincinnati Children’s has expanded that connection to include students and faculty from the UC Design, Architecture, Art, and Planning (DAAP) program as well. The Live Well Collaborative, a nonprofit established in 2007, emphasizes design thinking methodology and provides a program to bridge UC students with local organizations and healthcare providers. These multidisciplinary teams provide the opportunity for nurses to develop innovative ideas into reality. 7
2017 PATIENT SERVICES ANNUAL REPORT
ADL123 Device Healthcare systems are increasingly aware of the need for patients to be more effective managers of their health. Patients’ active participation in and adherence to their prescribed plan of care supports optimal health outcomes across all chronic disease populations. Pediatric oncology, immunodeficiency, and hematopoietic stem cell transplant (HSCT) patients are at increased risk of developing treatment-related toxicities including infections, oral complications and deconditioning. Evidence indicates the risk for these toxicities can be reduced by participation in key activities of daily living (ADL), including daily bathing with chlorhexidine gluconate, physical activity, and oral hygiene. Despite this evidence, many patients fail to perform these important ADLs during inpatient treatment, when they are most vulnerable. Victoria Hickey, MSN, RN, DNP(c), Quality Outcomes Manager, CBDI, recognized the critical need for sustainable interventions to engage patients in self-care activities and created a fun, rewards-based approach to improving outcomes. In an effort to engage patients and improve adherence to these activities, she designed and tested a paper-based token economy intervention in 21 HSCT patients with impressive results. In order to gain the ability to reliably extend the
1
5
6
PATIENT:
4
Adheres
2
PATIENT:
PATIENT:
Receives Points
Gets Small Prize
Electronic Medical Record (EMR)
3
STAFF OR FAMILY MEMBER:
CENTRAL SERVER:
Validate ADL Completion
Data Repository
system to a greater number of patients, the ultimate goal was to digitize the intervention and create engaging virtual measurement, rewards, and games to deliver productive fun to the bedside. Digitizing the token economy intervention required a team with knowledge and skills beyond Victoria’s professional scope. A partnership with the Live Well Collaborative provided a team of engineering and design students to work alongside Victoria and a Cincinnati Children’s lead software developer, John Huber, to create a digital token economy system. The ADL123 digital device system was created to not only generate fun at the bedside for patients, families, and the clinical team, but also support positive reinforcement for self-care behaviors. The digitized system provides adherence data and also has the potential to reduce documentation burden by interfacing with the electronic medical record. The ADL123 device has been tested and adapted in the clinical environment with consideration to patient and family feedback, has a provisional patent, and is currently being evaluated for impact on adherence to ADL in a randomized trial. Feedback from patients, families, and staff has been positive.
2017 PATIENT SERVICES ANNUAL REPORT
8
Anesthesia Induction Children commonly go to sleep with anesthesia by inhaling medications from a mask. Unfortunately, some children do not respond well, and may display behaviors such as crying, pushing away, kicking, screaming, and flailing. These negative behaviors during anesthesia inductions are associated with undesirable post-operative outcomes including more pain, emergence delirium, night terrors, tantrums, separation anxiety and bedwetting. Abby Hess, DNP, APRN, a nurse practitioner and researcher in the Department of Anesthesia, wanted to find a way to create a more engaging and calming anesthesia induction experience for kids. Abby researched techniques used to improve mask acceptance during inhalation inductions. With technology being an effective distraction technique for many kids, Abby also researched
9
2017 PATIENT SERVICES ANNUAL REPORT
basic techniques for developing video games for kids and learned some basic coding. She used this information to create a prototype of a game that could be played using the anesthesia mask. Abby partnered with our biomedical informatics team and the Center for Technology Commercialization (CTC) to write an innovation grant, which featured the prototype innovation and was funded by Cincinnati Children’s. The project has involved significant internal collaboration across departments, including Anesthesia, Patient Services, Child Life, Surgical Services, Biomedical Informatics, the Center for Technology Commercialization, Clinical Engineering and Infection Control. Abby’s team has also partnered with two local companies: The Live Well Collaborative and Kinetic Vision. The Live Well team (led by UC DAAP students and faculty) spent one semester conducting market research and designing products to create an optimal induction experience for kids.
“The best part of our project has been discovering new ways to help children of all ages feel more engaged in their healthcare experience. Making scary or challenging procedures easier for kids benefits the patient and everyone involved in their care.” - Abby Hess
The final product design considered all phases of the perioperative experience, from admission to discharge, and was created with input from the key stakeholders in the process – clinicians, families, and kids. Once the product design was developed, the team needed to create a functional prototype for clinical testing. Abby’s team is currently partnering with the engineers at Kinetic Vision to create the functional prototype. Testing with research participants is planned to begin in early 2018.
Home Care for Heart Health The consequences of parents being ill-prepared for discharge from the hospital and the ongoing life-long home requirements of children with congenital heart disease (CHD) are significant. Early and repeated parent home care education is important to preparing parents for managing their child’s health and avoiding postoperative complications. To effectively educate parents, clinicians must have adequate knowledge of the child’s condition, ongoing healthcare needs, adult education fundamentals and strategies, and possess strong communication and evaluation skills. One solution for improving outcomes after pediatric cardiac surgery was to develop a structured home care education intervention for parents of children with CHD and their healthcare team starting with the parent/child’s first introduction to our Heart Institute and following parents through their child’s follow-up care. A Cincinnati Children’s study team led by Sandra Staveski, PhD, RN, APRN, nurse scientist, Research in Patient Services and the
Heart Institute, worked with the Live Well Collaborative to convene an expert panel to co-create the Home Care for Heart Health (HCHH) intervention. The panel consisted of 12 interdisciplinary clinicians with extensive experience caring for children with CHD, 14 parents of children with CHD (both high-literacy and low-literacy), and 5 Live Well Collaborative members including University of Cincinnati students and faculty with expertise in design thinking methodologies and strategies. The main development work for educational materials was accomplished through a series of focus groups and individual sessions organized by the Live Well Collaborative. As the team co-created draft educational materials, they further consulted and tested the draft materials with a wide range of stakeholders and potential end-users. Input from these consultations was discussed at subsequent study team meetings, conference calls, in-person meetings, and focus groups. The intervention includes animatedinteractive clinician education, diverse parent home care education materials
HCHH Development Panel:
12 interdisciplinary clinicians 14 parents 5 Live Well Collaborative employees
(including a visually appealing quick reference guide with iconography and pictograms for low literacy parents/ caregivers and a digital application), and staff engagement implementation strategies including unit champions across the care continuum. The HCHH study team has collected parents’ perceptions of readiness for hospital discharge, uncertainties, their ability to manage home life after discharge and information about child outcomes before implementing the HCHH intervention. The entire Heart Institute interdisciplinary team was educated about the intervention via two animated videos describing the intervention and the teach back method for educating families. The study team and unit champions were instrumental for successful implementation of the intervention across the care continuum. The study team continues to collect post implementation data for comparison and hopes this pilot study will lead to further investigations. 2017 PATIENT SERVICES ANNUAL REPORT
10
Critical Care Building Planning
Employees Drive the Future
The Critical Care building design reflects the voice of the Cincinnati Children’s Hospital Medical Center Employees. For obvious reasons, the Cincinnati Children’s 2017 project that stands out to many is the Critical Care Building, which broke ground in October. Set to open in early 2022, the building design is the result of a collaborative effort of a team of Cincinnati Children’s staff, former and current patient and families, ZGF Architects, GBBN Architects and Messer Construction. This group spent the last year planning the design of the building, identifying every patient and family need, and anticipating the tools and the space clinicians require to perform at their peak. Because of their work, this building will provide the infrastructure needed to deliver on our mission of providing the best patient and family experience and exceptional delivery of care. Together with patients and families, more than 150 staff – the majority being direct care nurses and allied health employees – took part in the planning process, which included 13 design workshops, warehouse mockups, yarn mapping to demonstrate flow, clinical simulations, and drone video tours. The design team used lean-led methodology to simulate clinical practices, which enabled the interdisciplinary team to improve processes and evaluate design modifications before the actual build starts.
11
2017 PATIENT SERVICES ANNUAL REPORT
The Critical Care building is more than additional space. Its design reflects the needs of critically ill patients and the respite that is crucial to parents, caretakers and staff. This facility will provide: • 48 Pediatric Intensive Care Unit (PICU) and 24 Complex Airway inpatient rooms • Expansion of the Cancer and Blood Disease Institute (CDBI) program with 48 Bone Marrow Transplant (BMT) inpatient rooms. • Expansion of the Neonatal Intensive Care Unit (NICU) with 48 private inpatient rooms • State-of-the-art cardiac operating rooms adjacent to 48 cardiac intensive care inpatient rooms • New Emergency Department with embedded imaging and Pharmacy departments • Expansion of the Fetal Care program with fetal operating rooms and Labor and Delivery rooms • Right-sized Clinical Laboratory and Pharmacy, dock and receiving area, Sterile Processing and Clinical Engineering departments • Critical Care Pharmacy • Parking and utility building • Outdoor spaces • New kitchen, servery and dining • Shelled space for future operating rooms and ICU expansion
2017 PATIENT SERVICES ANNUAL REPORT
12
Critical Care Building Planning Nursing and allied health professionals have been involved in all aspects of space design, systems and processes, and have been strong advocates for not only the patients and families, but the clinical staff as well. Support space, such as exercise facilities for long-term families, was a high priority from the beginning. Both families and clinical staff needed dedicated lounges, respite and meeting space. Standardization was a guiding principal with regard to the staff who care for patients on various units. Room designs were standardized with designated spaces for patients, families and clinicians to store and access needed items. Patient lifts are planned for each room as needed for ergonomic support. Designs for medication and supply pass -through portals will enhance efficiency and productivity. In addition to helping lead the space and process design, nursing and allied health professionals explored how technology and equipment can improve insights
hallway charting station outside of patient rooms. Informed by direct care nurses on how the space is used, the work stations are equipped with the needed technology while optimizing in-room visibility.
and connections. One example is the
reality tour of the areas that were not
13 2017 PATIENT SERVICES ANNUAL REPORT
The mockup of a 12-bed clinical unit, cardiac operating rooms, Labor and Delivery room, and portions of the Emergency Department and Clinical Lab served as a learning lab to aid clinical staff in understanding space adjacencies, distances, room sizes, flows, and line of sight from corridors to each patient room. The use of the mockup supported elimination of 1,000 square feet from the floorplan, which significantly reduced cost and the distance traveled by staff. Mockups also allowed the clinical staff to appreciate the value of glass and open team spaces to improve line of sight and promote teamwork, improved flow, and safety. The design team provided a virtual
physically mocked up, bringing the 2-dimensional plans to life for the staff. In addition to the mockup space and virtual reality, a “cup model” was used to simulate the 7 Flows of Health Care and determine the ideal flow: flow for patients, families/visitors, providers, medications, supplies, information, equipment, instruments/ processes, food, and trash. The collaboration between clinical and ancillary staff was instrumental to designing a future space that facilitates efficient flow and processes. When it comes to designing the future, Cincinnati Children’s knows the key to moving forward is the voice of its employees.
150
More than staff, patients and families took part in the planning process
Cincinnati Children’s has seen a significant growth in the number of our sickest patients and is experiencing limitations of existing space to accommodate for new technology and the ability to expand our services for babies and children needing cardiac, intensive care and transplants.
2017 PATIENT SERVICES ANNUAL REPORT
14
One Admission Process: Reducing the Burden of Documentation Workflow Efficiencies MAR Volume Documentation Reduced 5 clicks and 25 – 55 seconds, which could save up to 7,200,000 clicks per year.
Single-Page Printed Worklist Mockup Estimated potential savings of 1,733,750 printed pages and $133,499 per year once implemented.
15 2017 PATIENT SERVICES ANNUAL REPORT
In November 2017, a new carefully-designed admission process went live in Cincinnati Children’s inpatient units. It was part of an interdisciplinary effort to reduce nursing documentation and increase care coordination. In 2016, the Patient Services Informatics team took on the goals to reduce the burden of nursing documentation by 50%, and implement one interprofessional admission process. A review showed the current admission process for nurses consisted of an overwhelming 200 rows and 500 options to chart. As a result of this, nurses often only made it through a select portion of questions they knew were needed or required. A survey of 224 nurses throughout the organization showed that approximately 63% of those polled only completed the red dot requirement questions, which took them between 10 and 30 minutes. In addition to this, much of the information asked was not being communicated to other areas, causing double documentation
and frustration in patients and families. To tackle the challenge, a Best Practice Technology Team was formed with Best Practice Shared Governance nurses and selected Allied Health champions. With clinical input from Nursing and Allied Health, and support from Information Services, the Informatics team began hosting monthly design challenge sessions in December 2016. The format of the design challenge sessions and feedback exchanges were based on design-thinking methodologies and emphasized strong empathy work, weekly feedback, and interactive design sessions to respect and lift the voice of those at the point of care.
The group began with an initial session grounded in empathy and focused on the process of admitting. During this session nurses worked alongside allied health clinicians to identify common themes in the experience of documenting. Themes such as variations in process, double documentation, and searching for information emerged and helped to focus the process going forward. They continued to work together in the next sessions covering topics such as care planning and outcome evaluation, One Admission process, one-page printed worklist, longitudinal plan of care (LPOC) and MyStory. As the design sessions moved forward, clinicians helped identify areas in need of better information flow, sources of conflict or confusion, and nonvalue added information to be eliminated. They also improved the Medication Administration Record (MAR) volume rows and redesigned a printed worklist to fit in a single page. Through the sessions, a picture of the new process began to emerge. In just six months, the group had successfully designed one interprofessional admission process utilizing MyStory. The next design challenge was a review of a full prototype of the one admission process – a reflection of all the information and feedback gathered throughout the challenges. Once the prototype was set, members of Information Services, who had been a part of the design challenges from the beginning, began making the recommended build changes in the Epic system. At the same time, an education initiative spread awareness and trained direct care staff. Utilizing collaborative meeting announcements, training tools, MyStory awareness and an interactive playground environment, staff were prepared for the change.
Admission Documentation Workflow Count of Actions 150 100 50 0
Mouse Clicked Prior Admission Process
21
Minutes
Keyboard-Mouse Transistions One Admission Process
Prior Admission Process 33 Keyboard-Mouse Transitions 150 Mouse Clicked 45 Free Text Flows 220 Navigator Rows
10
Minutes
One Admission Process 12 Keyboard-Mouse Transitions
53 Mouse Clicked
12 Free Text Flows
75 Navigator Rows
Implemented at the end of November, the new process reduced admission documentation from over 200 rows and 500 options to fewer than 75 rows with cascading sections that hide questions when not relevant to the patient. They also reworded and reorganized sections for clarity and functionality. The new process also cut the median time spent documenting from 21 minutes pre-implementation to just 10 minutes, and eliminated the
need for nurses to skip through to mandatory questions. The Best Practices Technology Team continues to evaluate the effectiveness of their design, run design sessions to spread the One Admission process to the remaining areas, and look for other opportunities to create efficiencies.
2017 PATIENT SERVICES ANNUAL REPORT
16
A new position offers significant positive change.
Looking Out for Our Community
The role of Community Health Worker (CHW) is a recent addition to the Division of Social Services that evolved from the Health Care Facilitator (HCF) role in Pediatric Primary Care. Through early adoption of the statewide Medicaid program, the Comprehensive Primary Care encouraged increased community outreach. In 2017, six FTEs were hired to expand the existing team and continue to address population management and community outreach. Families living in poverty focus much of their time on meeting their basic needs. Primary medical care often takes a back seat to the social determinants that influence their health. In order for this work to be successful, CHWs must establish trust and strong family connections. Their advocacy and presence has allowed partnerships to build with families in the Avondale and Price Hill communities.
The team has made quite an impact on the SP20 Community Pillar goal to help Cincinnati’s kids be the healthiest in the nation. Between September and December 2017, the team has made contact with more than 80 community agencies and are engaged with more than 150 families in the Cincinnati area. CHWs are able to help families connect to social and medical systems to ensure care is received at the right place and appropriate time.
17
2017 PATIENT SERVICES ANNUAL REPORT
More than community agencies contacted
80 150
More than families actively engaged
Fifteen-year-old Brandon B. had uncontrolled diabetes and sustained a wound in August 2016, which resulted in a lengthy hospitalization and partial foot amputation in February 2017. Brandon is one of seven siblings raised by his mother, Anna. Together they have faced many hard decisions and have worked to maintain a family with limited available resources. His primary medical care and diabetic maintenance proved to be troublesome. In September 2017, Brandon met Stephen Fortson, a new CHW. Stephen was able to make a meaningful connection and engage Brandon and Anna, who had lost faith in the healthcare system and had given up their pursuit of it. Over the next few weeks, Stephen became a strong advocate for both mother and son. Stephen met with
Brandon at school and was able to attend an IEP meeting that addressed school work, diabetic care at school, and a new plan to reduce his daily bus rides from three transfers to two transfers. Stephen also encouraged the family to reconnect with orthopaedics and attended most of Brandon’s orthopaedic appointments. Brandon is now engaged in his care, attending regular physical therapy visits, and is walking without crutches on a new prosthetic foot. Anna is supported, encouraged, and hopeful for her son’s future. This is one of many examples of how Cincinnati Children’s CHWs are changing the outcome.
2017 PATIENT SERVICES ANNUAL REPORT
18
COMMUNICATION SCIENCES RESEARCH
Speech-Language Pathology’s STAR Feature Patient: Kaleb
CENTER
Kaleb is a talented 6-year-old who started first grade in September. He enjoys participating in Mixed Martial Arts, learning about the solar system, and collecting Shopkins. Kaleb is very bright and has an amazing memory. He has already memorized the capitals for all 50 states! Kaleb also has a language disorder, which means he has had to work very hard to learn new words, make sentences, and express his ideas. Kaleb started receiving speech and language therapy services at Cincinnati Children’s Hospital when he was just 2 years old. At that time, he was very quiet. His hearing was normal, and he appeared to understand what was said to him, but was not sure how to talk about what he saw or needed. He did not know how to share his interests or feelings with others. He preferred to play by himself and did not like it when other people tried to play with him. To help Kaleb develop language, his speech-language pathologist (SLP) had to find ways to connect with him. She followed Kaleb’s interests so that he would want to talk and play with her. When Kaleb turned crayons into cars 19
2017 PATIENT SERVICES ANNUAL REPORT
and bowling pins into people, so did she! He liked that she took an interest in his style of play, and he responded well. Over the course of therapy, it was important to work Kaleb’s language goals into activities that he liked. His SLP and he went on shape scavenger
hunts and made letters and numbers in Play-Doh. They drew pictures of the solar system and completed puzzles of the United States. They even created their own Shopkins version of the popular game “Guess Who.” Kaleb became more engaged when therapy focused on following his interests and his lead. Kaleb’s family and teachers
60,000
times courses have been viewed The division of Speech-Language Pathology partnered with Allied Health Media (AHM) and speechpathology.com to develop more than 40 continuing education courses for speech-language pathologists (SLPs). Their courses have been viewed and reviewed more than 60,000 times, by professionals in all 50 states and numerous foreign countries. Allied Health Media and speechpathology.com are well known, well respected educational companies. The benefits of the collaboration have been far reaching, including exposure that has heightened the division’s national and international reputation as a leader in pediatric speech-language pathology, and widespread recognition of their SLPs as national experts.
also worked hard to support his language learning. As a result, his communication skills soared. Kaleb continues to benefit from speech and language services, and is currently participating in a Social Skills Group with other children his age. He can now share his own interests and feelings
with others. He is also learning how to find out about other people’s interests and feelings. He is working on how to think about another person’s point of view, how to ask questions, and how to start and have conversations.
Bad Wolf in his classroom’s production of the “Three Little Pigs.” He gave a speech in front of his classmates called “How to Draw a Rainbow.” He is now
a confident communicator! Way to go, Kaleb!
Today, Kaleb is one of the top readers in his class. He was recently the Big 2017 PATIENT SERVICES ANNUAL REPORT
20
COMMUNICATION SCIENCES RESEARCH CENTER
Ann Brandner Award — Social Work winner — Rosanne Cahill, MSSW, LSW (second from right) with Stacey Litman, Yvonne Stepter, and Judy Wood (left to right)
Patient Services Awards
Ruth Lyons Award of Child Life and Integrative Care Distinction
David Gerard Huschart, RPh Pharmacist Excellence Award
Emily Jones, Child Life Specialist III
Judy Knapp, RPh
Zenith Award, Respiratory Therapy
Carolyn Stoll Award
Jerry Edens, Respiratory Therapist III
Abby Hess, DNP, APRN
Ann Brandner Award — Social Work
Barbara Jean Black Technical Excellence — Pharmacy
Rosanne Cahill, MSSW, LSW
Faith Groneck, BS, CPHT
Director’s Award for Excellence — Speech-Language Pathology
Award for Clinical Excellence in Occupational Therapy/ Therapeutic Recreation
Alison Riley, Speech Pathologist III
Jennifer Clausing, OTD, OTR/L
Nursing Awards • B. Robison-Sporck Award Rae Becker, BSN, RNII, CPN • Susan R. Allen Leadership in Nursing Award Sharon Foreman, MSN, RNIII, CPN, CPEN, CNL
Award for Clinical Excellence in Physical Therapy Shannon Brausch, PT, DPT
Award for Service Excellence in Division of OT, PT, TR Kyle Malblanc
21
2017 PATIENT SERVICES ANNUAL REPORT
Melanie Hunt Registered Dietitian of the Year Award
Managing Success Award
Jennifer Phillips, MS, RDII, CNSC, LD
Diane Herzog, MSN, MBA, RN, CCM
B. Robison-Sporck Award winner — Rae Becker, BSN, RNII, CPN
Zenith Award, Respiratory Therapy winner — Jerry Edens, Respiratory Therapist III with Cheryl Hoying, PhD, RN, NEA-BC, FACHE, FAAN
Robert E. Davis Award of Excellence — Patient Escorts Gabriel Platt
Maggie P. Montgomery Award — HUC Renee Stiles
Carol McKenzie Award for Excellence in Advanced Practice Nursing Jeanne Weiland, MSN, APRN, CNP
Carolyn Stoll Award winner — Abby Hess, DNP, APRN
Ruth Lyons Award of Child Life and Integrative Care Distinction winner — Emily Jones, Child Life Specialist III
Carol McKenzie Award for Excellence in Advanced Practice Nursing winner — Jeanne Weiland, MSN, APRN, CNP
Managing Success Award winner — Diane Herzog, MSN, MBA, RN, CCM
2017 Daisy Awards Kim Grote, LPN Amanda Williams, BSN, RN Frances Gadd RN, RNC-NIC Molly Ihlendorf BSN, RNII, CPHON Emily Coffman, RN Brittany Emmerich, BSN, RN Bonnie Tedtman, RNII, CPN Reilly Rampton, BSN, RN, CPN Jenette Tuada, BSN, RN Kimberly Duffey, MSN, RN Tiffany Whitaker, BSN, RN David Ulmer, BSN, RNII, CPN
2017 PATIENT SERVICES ANNUAL REPORT
22
Optimal Outcomes Hospital Facts and Figures — 2017 Number of beds licensed
678
Number of beds staffed
632
Number of ambulatory clinic visits Number of admissions Number of RN FTEs
23
2017 PATIENT SERVICES ANNUAL REPORT
532,857 19,347 3,043
RN skill mix
87.7%
RN turnover rate
10.4%
RN vacancy rate
3.8%
RN Professional Development
45.2%
94.5%
Percentage of certified direct care RNs
Percentage of certified RNs serving in leadership positions
15
Allied Health publications
78
Allied Health presentations
2,021
Total number of RNs who have nationally recognized certification
RN Continuing Education RN Continuing Education
12
Number of Nursing Grand Rounds live presentations
686
Number of nurses who attended Nursing Grand Rounds
2,576
Number of nurses who attended Nursing Grand Rounds online
242
Undergrad cohort groups
1,467
Undergrad students completing clinicals
132
Graduate students completing clinicals
331
Allied Health students completing clinicals
1,930
Total students in patient services
Student Information
2017 PATIENT SERVICES ANNUAL REPORT
24
Highest nursing degrees overall for RNs
Nursing Continuing Education
ADN/Diploma BSN
2,346
MSN
869
Doctorate Doctorate
Total
25
2017 PATIENT SERVICES ANNUAL REPORT
509
50 3,774
Highest nursing degree for RNs who provide direct care
16.5% 443
ADN/Diploma
74.2% 1,997 BSN
.1%
9.2% 248
4
MSN
Doctorate
Total 2,692 Goal Met: 83.5% BSN or higher meets Institute of Health Future of Nursing Recommendation for 80% BSN by 2020
Highest nursing degree for RNs in leadership positions
0.2% 1
ADN/Diploma
3.7% 18
BSN
89.2%
6.9%
437
34
MSN
Doctorate
Total 490 Number of employees who received nursing degrees in 2017
27
ADN/Diploma
256
BSN
61 MSN 16 Doctorate Total 333
360
Total
2017 PATIENT SERVICES ANNUAL REPORT
26
Research in Patient Services
2017 in review Faculty
8
Joint Appointment Faculty
9
Research Fellows and Post Docs
5
Research Graduate Students
1
Total Number of Publications
25
Research Grant Dollars
27
2017 PATIENT SERVICES ANNUAL REPORT
$2,142,617
2017 Nationally Recognized Nursing Certifications Certification demonstrates to patients and families that we are the most skilled and experienced nursing professionals.
Lindsey Abbott Judith Ackermann Devin Adler America Ahmed Erik Albers Jessica Andres Katherine Andrews Stephanie Anglin Michelle Anton Taylor Arnold Katie Ashley Heather Audas Victoria Back Leah Baker Miriam Baker Rowena Balein Brooke Barganier Kristine Barnett Jessica Barolo Lopes de Araujo Kylie Bates Terri Baumann Bernadette Beane Kimberly Behne Taylor Belew Kelley Bender Jenna Bezold Jennifer Bibbins
Denise Bierbaum Tami Bishop Sheryl Ann Bloomer Jennifer Marie Boberschmidt Claire Bohne Danielle Bollinger Virginia-Ann Bossman Jaclyn Bowlin Erin Bowman Lauren Boxell Lindsay Boyer Amy Brauch Kelly Brians Kymbre Brinker Lauren Broering Allison Bruggeman Brynn Buchanan Debra Buck Jennifer Buckley Katie Buckley Mary Pat Burke Margaret Burress June Burt Megan Byerly Rhonda Cable Emily Callahan Leah Carnes
Stephanie Carroll Anita Carter Carole Castillo Alexandra Caudill Lindsay Chadrick Rachelle Chitkara Lois Churchill Katie Clark Rachel Clendenin Nicole Click Ivy Cline Allison Cohen Julie Cook Rhonda Cooper Mary Anne Coulson Melissa Cowles Theresa Cox Jennifer Craven Kristi Curtsinger Mandy Dahlinghaus Lauren Dardeen Gina Gay Davidson Avery Davis Shannon Deidesheimer Emily Devers Melanie Dial Jamille Dias-Srivastava Sarah Dinkelacker
Victoria Dittrich Leslie Dobbelstein Mikeisha Dobbins Sara Donovan Melissa Dowler Erin Doyle Christa Duff Terressa Dugar Julie Dydo Rachel Dyke Marcia Early David Edwards Jeannie Elliott Wendy Engel Jodi Engelhardt Dorothy Everts Rhonda Fecher Rebecca Fink Maureen Finnegan Rene Flores Teresa Flower Sharon Flynn-Nelson Sharon Foreman Rachel Fox Julie Fugazzi Sandra Gady Natalie Gaige Lorrie Gates Elizabeth Geers Angelica Gladish Kari Glasshagel Carla Glos
2017 PATIENT SERVICES ANNUAL REPORT
28
2017 Nationally Recognized Nursing Certifications Amanda Gorman Joann Graham-Case Ellen Grammel Colleen Griffin Dulcey Griffith Kristen Griggs Elizabeth Groh Jessica Grover Blake Gustafson Angela Gutzwiller Bridgette Hagen Katherine Hale Lisa Hallum Mary Hamilton Becky Hammoor Barbara Hanlon Jessica Harmon Pamela Harris Sarah Harris Kimberly Hartley Maribeth Harvey Kristal Hatter Stephanie Haubrock Michael Hegman Kara Henningsen Diane Herzog Emily Hess Molly Hicks Beth Marie Higgins Michelle Hils Jennifer Hodges Mindy Holden Tiffany Holt Melissa Hosmer Amy Huebner Sandra Huff Kassie Huffmaster Sara Hughes Mary Hughett Jessica Huwer
29
Ashley Jansen Paige Jarrett Leanne Jayakaran Amanda Jennings Abigail John Chima John Patricia Ann Johnson Kira Jones Regina Jones Janet Kaufman Emily Kauscher Kimberly Kennedy Kimberly Klumb Gayle Knapp Julie Koch Rachel Kohlman Jennifer Kondik Logan Konitsch Connie Lynn Koons Tamera Kopser Kathy Korte Sarah Kozma Emily Kraft Kathi Kramer Mary Beth Kramer Tonjia Kramer Jessica Kretzer Katilyn Kusnier Kimberly Lane Angela Lattire William Lecher Emily Leisge Alice Lengerich Stacy Marie Levi Michelle Lewyckyj I-Chun Lin Margaret Linker Melissa Lipps Katherine Lohbeck Ashley Lonsbury
2017 PATIENT SERVICES ANNUAL REPORT
Kimberly Lopez Leslie Lopez Emily Luksic Connie Lunsford Jennifer Lutz Jenna Macke Anne Marraccini Deborah Martin Julie Martina Rachel Mastin Angela Matacia-Huth Jennifer Mattei Cheri McCurley Amanda McGinnis Natalie McGrath Gail McMonigle Amber Mehle Brant Merkt Anne Mescher Cynthia Meyer Martha Miele Allison Miller Candice Sue Moore Margo Moore Samantha Moore Mary Morgan Brenda Mott Elizabeth Mueller Sarah Mullenix Kathleen Murphy Vicki Murphy Jennifer Murray Christine Myers Jacqueline Napoli Adam Neace Kara Neel Kathryn Newsom Vickie Neyer Brenda Nicholson Renee Niehaus
Jana Norvell Kathleen Novak Leigh Nuzum Kaylin Ogden Megan OMaley Lauren Orndorff Deborah Lynn Parrott Catherine Perkins Jody Petru Tahler Peveto Holly Marie Pfriem Katherine Potts Carrilee Powell Jennifer Proffitt Tiffany Proto Sara Puckett Jeanne Race Angelia Radcliffe Rachel Ransick Mary Ratliff Denia Jean Redford Melissa Reed Mary Reeder Deborah Reeves Katie Reilly Lindsay Richard Lena Riley Amy Ritter Stephanie Robinson Christina Roedersheimer Gretchen Rogers Van Romer Kristi Rose Christopher Ross Lisa Routt Kristen Ruehlmann Becky Russo Jacqueline Ruter Alyssa Sajna Megan Sandlin
Jennifer Saupe Sandra Sayers Rebecca Scalf Tiffany Scherer Becky Scheve Nathan Schiesler Amy Schmidt Christin Schneider Devin Schnipke Jenna Schnitker Samantha Schoborg Pamela Schrand Laura Schroer Amy Schubert Ashley Schuckman Carrie Schultz Mary Schumacher Emily Schwarzmann Juliann Schwieter Colleen Scott Andrea Seaborn Kristen Sells
Chelsea Sensibaugh Rachel Sheets Patricia Shipp Jeffrey Shoemaker Ashley Simon Darlene Sipos Nicole Slomiany Allison Smith Jennifer Sorrell Amy Sparks Carrie Spreen Julie Stalf Taylor Stammer Jane Stanberry Beth Ann Stockman Angela Strotman Michelle Swartz Tori Switzer Michelle Tate Brittany Taylor Brooke Tepe Leah Terhune
Christina Thomas Tasha Thompson Cindi Tillman Barbara Tofani Angela Tucker Debra Uehlein Rachel Vakerics Sarah Vanover Amber Vater Claudia Velez Yvonne Vetter Molly Villari Carolyn Vincze Adam Voegele Connie Walder Amanda Wallace Megan Wandersleben Sarah Wayman R Weaver Katherine Weber Cristan Weekley Amanda Weiglein
Nicholas Weissman Ashley West Jean Whalen Rebecca Whatley Donna White Jessica White Vonda White Robin Widing Jenny Wilfong Jennifer Wilkey Rachel Wirtz Sarah Wise Lisa Witte Kate Wolery Anne Wolfe Sarah Wolfram Tammy Wroot Connie Yoho Ann Yoss Ashley Ziegler Katherine Zix
2017 PATIENT SERVICES ANNUAL REPORT
30
www.cincinnatichildrens.org
022018_200_BRV261415