Approved Projects for Physicians with a Relationship with Seattle Children's or Its Affiliates

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.  

Antimicrobial Toxicity Education and Monitoring

Renal toxicity is a common side effect of many antibacterial, antiviral, and antifungal agents (antimicrobials) and antimicrobials are frequently implicated as agents responsible for acute kidney injury in hospitalized patients, particularly when administered in conjunction with other nephrotoxic agents. In conjunction with the Seattle Children’s pharmacy, the ID division developed recommendations for laboratory monitoring for the most commonly implicated antimicrobials. However, knowledge and implementation of the recommended monitoring is not consistent.

The ID division developed templated antimicrobial monitoring language, which the clinicians have been asked to include in consultation notes when one of the relevant antimicrobials is recommended. Baseline data shows that the templated language is being used about 20% of the time. The goal of this project is to increase the use of the antimicrobial monitoring template language in the Infectious Disease consult notes when the relevant antimicrobials are being recommended. This project will be a first step towards the overarching goal of increasing the level of recommended monitoring conducted for specific antimicrobials when prescribed in-patient at Seattle Children’s Hospital.

Community Provider Relations – Now Enrolling

The aim of this project is to improve communication between primary care physicians and Seattle Children's Hospital physicians and to decrease the incidence of complaints around communication. The first cycle improved and standardized content on the discharge fax. The second cycle with focus on increasing use of information provided by PCPs to specialists. Participants will be expected to attend three meetings, actively participate in project interventions and assess progress made towards goals. Improvement of communication between inpatient and outpatient providers will lead to enhanced care.

For more information or to participate, contact the MOC team.

CUMG Connect – Now Enrolling

Seattle Children’s Hospital strives to provide the highest-quality care from the perspective of patients and families. Although our Family Experience Survey scores are good, we know they can be great. In fact, over half of our physicians report that we do not consistently provide the patient experience that they would want for their own loved ones. Currently, physicians report they are unaware of both patient and family perceptions and strategies that can improve those relationships. The goal of the Children’s University Medical Group (CUMG) Connect project is to improve the overall scores of the Family Experience Survey and the scores on questions related to physician communication by November 23, 2015. Participants will increase awareness of family perceptions through sharing and evaluation of data, and they will learn about and implement strategies to enhance physician communication skills.

Participation in this project is limited to physicians who work for Children’s University Medical Group.

For more information or to participate individually or as a division, contact the MOC team.

Handoff Coaching – Now Enrolling

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.

For more information or to participate, contact the MOC team.

Head CT Utilization for Pediatric Head Trauma Patients

Pediatric blunt head trauma is a common reason to seek Emergency Department (ED) care in the US, resulting in 650,000 visits per year. Patients with minor head trauma can present a diagnostic challenge due to the need to quickly identify serious traumatic brain injuries (TBIs) while limiting the radiation exposure, sedation risk and cost from computerized tomography (CT). Children are particularly susceptible to the carcinogenic properties of radiation; it is estimated that one case of leukemia results from every 5,250 head CTs performed on children less than 5 years old. Clinical prediction rules have identified patients at very low risk for TBI, but there remains significant practice variation across hospitals in the rate of CT scans for pediatric head injury. In particular, head CT rates are significantly higher among patients who present to general EDs (22%) as compared to pediatric EDs (13%). This is important because 89% of emergency visits in the US for patients under 14 years old are to general EDs.

The goal of this project is to reduce the head CT utilization rate among pediatric head trauma patients seen at St. Peter Hospital ED from 71% to 25% in 12 months. We have adapted the PECARN clinical prediction rule to a pathway for use in our ED. In addition, we are providing feedback to individual practitioners on their rates of CTs. We are improving handouts given to parents in order to emphasize the role of observation on management of pediatric head injury.

Participation in this project is limited to faculty working in hospitals affiliated with Seattle Children's.

Increasing Influenza Vaccination Rates for Ambulatory Clinic Patients

On average, only 65.3% of our chronically ill patients followed in our outpatient clinics were vaccinated against influenza in 2012. Many outpatient encounters do not have a completed screening for influenza vaccination during the targeted time period. Overall, there is a lack of standard work across clinics to integrate influenza screening into clinical practice. The goal of this project is that greater than 90% of all medically fragile populations (as defined by US News & World Report) seen in our outpatient clinics between October 1 and December 31 each year will receive influenza vaccination and their status will be documented in CIS.

Participation in this project is limited to physicians who work at Seattle Children's.

Increasing Vitamin K Administration Rates in the Newborn Nursery

Rates of routine Vitamin K administration in newborns at Providence Everett Medical Center, a Seattle Children's regional hospital, are perceived to be declining.  There has not been an adequate way to document the refusal, provide information to the families, and notify the physician.  Participating physicians will attend at least three team meetings, attend at least one nursing staff meeting to participate in their educational training, actively participate in design of the refusal form, and complete chart reviews.

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.

Non-Invasive Ventilation (NIV) in the Neonatal Intensive Care Unit

There are excellent data in the premature infant that lower rates of intubation result in lower rates of bronchopulmonary dysplasia and death. Our NICUs have many patients who are intubated and ventilated for long periods of time. We believe that we could shorten the length of intubation by implementing a standard strategy and guideline for non-invasive respiratory support. We want to increase our rates of non-invasive ventilation and decrease the number of days our patients are intubated.

We have developed guidelines for extubation, for respiratory support after extubation and for re-intubation. The goal of this project is to increase adherence to these respiratory management guidelines, and through these guidelines to increase our use of non-invasive ventilation and decrease the number of intubated patient-days. In addition, we will follow our rates of complications of both intubation and non-invasive ventilation, including number of re-intubations, nasal damage, ventilator associated pneumonia and tracheitis. We also monitor our NICU outcomes and complications (mortality, incidence of bronchopulmonary dysplasia, length of stay, etc.).

After implementation of these guidelines, we will expand this work to decrease the number of patients intubated at birth by more consistent use of non-invasive ventilation and pressure support in the delivery room.

Promoting First Relationships in Pediatric Primary Care – Now Enrolling

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.

For more information or to participate, contact the MOC team.

Reach Out and Read in the Neurodevelopmental Clinic

Seattle Children's Hospital's Neurodevelopmental Clinic participates in the national Reach Out and Read program that provides children 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 as well as participate in committee meetings and presentations based on the national ROAR program's sequenced webinars. Physicians will be responsible for selecting books for their clinic patients, distributing the book and a short family survey during the clinic visit. Peer coaches will act as auditors to observe, evaluate and provide guided feedback regarding clinic staff's adherence to a prescribed checklist.

Rounding Coach – Now Enrolling

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.

For more information or to participate, contact the MOC team.

Screen-Refer-Treat

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).

Spirometry 360

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.

Our program is based at the University of Washington in the Department of Pediatrics, where four of us do our work. We are, however, a distributed organization. Beyond Seattle, key team members live in Vashon, Washington; Wenatchee, Washington; McMinnville, Oregon; Burbank, California; Phoenix, Arizona; and Valhalla, New York.

To participate, contact the project leader, Dr. James Stout.