We are excited to offer opportunities for physicians to learn how to continuously improve the delivery of care to their patients. The following is a list of projects currently approved for ABMS Part 4 MOC credit.
Unless otherwise stated, these projects are only available to physicians with a relationship with Seattle Children’s or its affiliates.
Abdominal CT Utilization in Pediatric Appendicitis at Community Hospitals
This project focuses on decreasing CT use and increasing ultrasound use in pediatric patients presenting to community hospital emergency departments with appendicitis. Participants will work to implement and disseminate a clinical protocol as well as standard work to reduce equivocal ultrasound reads. Participation in this project is limited to physicians who work at Seattle Children’s, Providence Regional Medical Center – Everett, and Providence St. Peter Hospital - Olympia.
BRUE Implementation Collaborative
Recently, the American Academy of Pediatrics (AAP) published a Clinical Practice Guideline for Brief Resolved Unexplained Events (BRUEs). The BRUE Implementation Collaborative is a partnership with researchers from the Children’s Hospital Association and 10 other children’s hospitals that aims to improve adherence to the recommendations. Participation in this project is limited to physicians who work at participating sites.
Community Provider Relations – eReferral Improvements
The aim of this project is to improve communication between primary care physicians (PCPs) and Seattle Children's Hospital physicians in order to improve patient, PCP, and consulting provider satisfaction. The first cycle improved and standardized content on the discharge fax. The second cycle focused on increasing use of information provided by PCPs to specialists. The current cycle aims to increase the use of electronic referrals (eReferrals) and utilize the attachment feature to include supporting documents with each eReferral. Participants who are already successfully using eReferrals act as coaches and share their experiences for improving the use of eReferrals; remaining participants identify interventions specific to their clinic environment and implement.
Dialogue on Acute Respiratory Tract Infections (DART)
The prescribing of antibiotics for childhood acute respiratory tract infections (ARTIs) is common in the United States. In outpatient settings, more than 50% of children diagnosed with ARTIs are prescribed antibiotics. However, the US prevalence of pediatric bacterial ARTIs (rather than viral) is estimated at 27%, signifying a substantial degree of antibiotic overuse nationwide. Research has also determined that provider-parent communication during outpatient pediatric visits is a driver of unwarranted antibiotic prescribing. The DART MOC Project aims to decrease unwanted antibiotic prescribing for specific ARTIs while increasing use of specific communication strategies and parent satisfaction. Participation in this project is limited to physicians already enrolled in this project.
Equity, Diversity, and Inclusion
The aim of this MOC project is to improve equity, diversity, and inclusion, and integrate a culture of equitable, diverse, and inclusive practices at Children's. This project builds on the 8-hour Equity, Diversity and Inclusion (EDI) training – a prerequisite for this MOC project. This project offers a unique opportunity for physicians to deepen their understanding of core concepts, reflect on their experience, and implement changes in their own practice.
Handoff Improvements – Seattle Children’s Rehabilitation Unit
Patients admitted to the Rehab unit are typically transferred from another inpatient service at Seattle Children's. There are opportunities to improve how physicians handoff important information to other providers which could lead to better patient safety or family satisfaction. Participants in this project will commit to giving and seeking out an attending-to-attending handoff as well as provide feedback on the quality and efficiency of the handoffs while tracking their data over time. Participation in this project is limited to physicians who work on the Rehabilitation Team at Seattle Children's.
Improving NAS in Community Hospitals
Infants exposed to opioids in utero may develop neonatal abstinence syndrome (NAS), a constellation of neurologic, gastrointestinal, and musculoskeletal disturbances associated with opioid withdrawal. This project seeks to improve care for opioid-exposed infants by decreasing scheduled morphine use and reducing length of stay. Participant involvement includes one or more of the following activities: continued education for bedside nurses on updates to NAS care, revising the family hand-out on NAS, performing case reviews; and Eat-Sleep-Console (ESC) chart auditing. Participation in this project is limited to physicians who work at Seattle Children’s, Providence Regional Medical Center - Everett, and Providence St. Peter Hospital – Olympia.
Increasing Influenza Vaccination Rates for Ambulatory Clinic Patients (Now Enrolling)
2016 Best Project
The overall goal of this project is to improve influenza screening rates in ambulatory settings at Seattle Children's through creating standard work. Specifically, this project aims to:
- Achieve an influenza vaccination rate of 90% for all medically fragile populations (as defined by U.S. News & World Report) seen in our outpatient clinics between October 1 and December 31 each year.
- Ensure their status is documented in CIS.
Participation in this project is limited to physicians who work at Seattle Children's.
P-HIP (Pediatric Hospital Improvement Project)
Seattle Children's is participating in a national quality improvement collaborative to improve the quality of discharge information provided to patients and families AND improving the documentation of counseling in patients with suicidality. The Children's-based team will identify areas for improvement, implement interventions, and set goals. The national collaborative will meet to share learnings and barriers. Participation in this project is limited to physicians already enrolled in the study.
Physician Leadership – Leader Standard Work
Seattle Children's launched a robust program in 2013 to improve the alignment of hospital (administrative) leaders and physician leaders around quality, reliability, and effectiveness of physician leaders through leader standard work (LSW). The effort currently focuses on leadership methods that include safety as a core value, leaders rounding to influence, feedback, performance accountability, and learning/implementing the system for daily improvement. Physician leaders are expected to demonstrate and model safety as a core value, round to influence using feedback, and use error prevention tools to identify and escalate issues. They submit data on these activities every week and attend a series of meetings to evaluate and improve upon their data. Participation in this project is limited to physician leaders at Seattle Children's.
Pulmonary Exacerbations in Cystic Fibrosis
Respiratory failure is the major cause of death in cystic fibrosis (CF). Repeated pulmonary exacerbations in CF accelerate a decline in lung function over time. At Seattle Children's, the CF team noted room for improvement in standard care as well as return to prior best baseline lung function following CF hospitalizations. Every admission represents an opportunity to obtain and maintain highest baseline FEV1. Participants in this project will work to implement and improve standard care practices for these patients, review data, and attend multi-disciplinary team meetings to discuss barriers and opportunities.
Reach Out and Read – Inpatient Reading Program
Seattle Children's Hospital's participates in the national Reach Out and Read program that provides eligible patients ages 6 months to 5 years with new books at each medical clinic visit. Reach Out and Read builds on the relationship between parents and medical providers to develop critical early reading skills in children while encouraging families to read aloud together. When functioning optimally, the program provides books to all eligible children at every clinical visit. Despite intentions to model this aim and practice, practitioners often fail to distribute books consistently due to concerns about time, forgetting or overlooking established protocols. This project aims to improve adherence to established protocols through coaching and evaluation of the process of getting the books to families. All participants will complete the Reach Out and Read online training program, engage medical teams to improve the rate of book delivery, and identify barriers and ideas for further improvements.
SHEEP (Sleep Health: Expectations and Evaluations for Physicians)
2017 Best Project
Physicians who do atypical shift work have disrupted sleep habits. This can lead to fatigue, insomnia, and other significant adverse physician and mental health consequences (shift work disorder). Suboptimal physician wellness subsequently can negatively affect patient care and patient safety. It can also lead to poor physician career satisfaction and poor physician retention (loss of physicians to other careers with more traditional work schedules or early retirement). This project aims to educate physicians about sleep disturbances due to atypical shift work and ways to mitigate these deleterious effects ultimately leading to better sleep habits, improved physician health, improved patient care and better physician retention. Participants will attend workshops, implement strategies, complete surveys and diaries, and review data at team meetings.
The aim of this project is to improve the early identification of ASD (autism spectrum disorder) and access to ASD-specialized interventions for toddlers 24 months old and younger. This is accomplished by universal primary care provider (PCP) screening at 18-month well-child visits and appropriate referral for early intervention. This project works to mitigate barriers to screening through a one-page checklist for the 18-month well-child visit, a training workshop for physicians, provision of tablets for use by parents in physician/clinic waiting rooms and completion of parental consent forms to facilitate communication between PCPs and early intervention programs. Participating physicians will commit to attending a kickoff teleconference, two follow-up teleconferences and an attestation teleconference. Additionally participating physicians will implement the screening/referral checklist into their 18-month well-child visit, complete self-report surveys on knowledge and practices at baseline and four subsequent time points and attend a two-hour training workshop on the Modified Checklist for Autism in Toddlers, Revised and Follow Up Interview (M-CHAT-R/F).
The mission of Spirometry 360 is to help clinicians succeed in providing the best respiratory care for their patients, including the use of routine diagnostic spirometry as a vital sign. Spirometry 360 achieves this by employing a variety of online communication technologies to deliver spirometry as a distance-training program.
The Spirometry 360 faculty includes a respiratory therapist and generalist as well as specialist physicians with an interest in respiratory medicine, teaching and improving care. The staff includes technical experts in online training, multimedia and other software production, health education and quality improvement.
Although this project is based at the University of Washington in the Department of Pediatrics, participants from across the United States are welcome. Prior participants include physicians from Vashon, Washington; Wenatchee, Washington; McMinnville, Oregon; Burbank, California; Phoenix, Arizona; and Valhalla, New York.
Well Child Visits and Immunizations in the Seattle Children’s Care Network
Overall preventive/immunization rates in the state of Washington are below national averages and below the Healthy People 2020 initiative goals. This project aims to increase immunization rates for healthy children to greater than or equal to the national 75th percentile (HEDIS) for patients in the Seattle Children's Care Network. Physician participants will gain awareness of their vaccination rates as compared to national averages/benchmarks, and will implement changes within their own clinics to ensure well child visits are being scheduled and that appropriate counseling around vaccinations is occurring, and document primary reasons for vaccine declination. Participation in this project is limited to physicians who are in the Seattle Children’s Care Network.
Adolescent Risk Behavior
This project has its foundation in the concept of motivational interviewing as a strategy for addressing adolescent morbidity and mortality related to health-compromising behaviors and the communication challenges primary care physicians face in working with teens and their parents. The global aim of this project is to increase teen motivation and awareness of healthy behavior choices and reduce the prevalence of high-risk behaviors. Participants will access training modules to provide strategies for engagement and increasing motivation, while their patients utilize an e-health screening app to track behaviors.
Ancillary Services Utilization
This project is focused on appropriate utilization and cost awareness for labs, radiology and/or pharmacy services, and the reduction of duplicated orders. The 2016 cycle of this project is focused on lab orders of CBC+diff in the inpatient setting. The 2017 Rheumatology cycle focused on reducing maintenance doses of rituximab prescribed to vasculitis patients, as well as increasing utilization of a preferred lymphocyte testing panel.
Antifungal Medication Utilization
This project aims to optimize utilization of antifungal drugs in at-risk populations at Seattle Children’s Hospital in order to reduce cost as well as risk of toxicity. The first cohort will focus on micafungin use in Hematology-Oncology/Bone Marrow Transplant patients. Participants will complete chart review; attend an educational session; assist in defining appropriate use and developing toolkits; and attend project meetings. This project is supported by Infectious Disease, Pharmacy and Hematology-Oncology.
2016 Best Project – Honorable Mention
Data from a variety of sources indicate that opportunity exists to enhance physician connection with patients and their families. Increases in trust and perception of empathy result in greater adherence to treatment and better clinical outcomes. With the myriad demands placed upon physicians, it is a challenge to be fully present with the patient and family. The CONNECT program workshop is designed to provide strategies and tools to enhance physician connections with patients and families by providing tools for being present, establishing trust, and demonstrating empathy within a context of self-discovery and establishment of new habits. This project aims to increase the frequency of the behaviors related to empathy, trust, and presence in individual physicians.
This project is focused on application of the Appropriate Use Criteria for first-time pediatric outpatient echocardiograms. Participants will conduct chart review of first-time orders and use the guideline to score the appropriateness. Over the course of the six-month project, the aim is to increase the mean appropriate use score of reviewed orders by 10%.
Effective communication among healthcare workers is crucial for safe patient care. Handoff of patient care between attending physicians is a well-recognized time when miscommunication can occur leading to medical errors. The goal of this MOC project is to develop and implement a standardized attending handoff process that will improve the communication and patient safety for our patients. Participants (handoff coaches) will learn about the best practices for handoffs, help implement and monitor adherence to a standard process for handoffs, learn to provide effective just-in-time feedback and collect data on critical information during handoffs.
Mechanical Ventilator Weaning
The aim of this project is to decrease median duration of mechanical ventilation by 1 day in mechanically ventilated Seattle Children's Hospital PICU patients by August 2016. Determining timing of optimal discontinuation of mechanical ventilation (MV) is often difficult. A weaning protocol for mechanical ventilation is likely to identify patients who are ready to be extubated earlier without increasing the risk of premature extubation. Physicians enrolled in the project will attend at least three team meetings, actively participate in application and implementation of eVentilator software to generate weaning recommendations as well as review survey data from Respiratory Therapists and Physicians to determine reasonableness of eVentilator recommendations.
Patient Education in Genetics Clinic
This project focuses on increasing the education provided to patients and families seen in Seattle Children’s Genetics and Biochemical Genetics Clinics. The 2017 cycle will focus on improving the frequency in which patients are receiving a paper educational handout at the time of their visit as well as creating standard work around noting the handout in the medical record.
Promoting First Relationships in Pediatric Primary Care
Pediatric medical providers are trusted and frequent points of contact for parents and have many opportunities to be able to support and strengthen the caregiver–child relationship within their routine pediatric care. Promoting First Relationships for Pediatric Primary Care is an evidence-based home visiting program developed by UW Barnard Center for Infant Mental Health that has been adapted for pediatric primary care settings through a collaboration with practicing pediatricians. The program offers both the foundational knowledge and the practical skills for medical providers to be able to incorporate relationship-based care into their daily practices. This project aims to increase provider observations, specific skills, and education around parent-child relationships. Participants will attend a one-day workshops and use the PFR Pediatric Visit Checklist over the duration of the MOC. Participants will also meet as a group periodically over the course of the project to discuss how they are incorporating PFR into their clinic visits, share strategies, identify and mitigate barriers to the project, and to identify specific aims for subsequent cycles of this project.
2016 Best Project – Honorable Mention
The aim of the Rounding Coach Project is to improve patient- and family-centered communication on rounds through peer observation and coaching. Patient- and family-centered care improves patient satisfaction, communication, discharge planning, medical education and patient safety. However, barriers remain. Organizational efforts are needed to improve rounds through adherence to recommendations, linking to patient satisfaction and creating a standard process. Coaches in the 2016 cycle will review data on rounds, perform baseline observations and select new goals for peer coaching and feedback. Participants will need to make a flexible time commitment of six to eight weekday mornings and early afternoons during the project period for rounds observations and coaching. The project will run approximately from February through July.
This project is focused on improving the efficiency of rounds in the Cardiac ICU. By reaching agreement on the purpose of rounds; eliminating variation in information presented during rounds through development of standard work; and implementing data collection methods, the participants of this project aim to reduce rounding time by the completion of the project.