Approved Projects for Physicians with a Relationship with Seattle Children's or Its Affiliates
We are excited to offer many 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.
Assuring Vitamin D Sufficiency in Children with Cerebral Palsy
All children in the Pacific Northwest are at some risk for vitamin D deficiency. Children with cerebral palsy (and many other physical disabilities) are at high risk for vitamin D deficiency, osteoporosis and low-impact fractures. Since 2009, our Neurodevelopmental Clinic team has been running a QI project to assure that 25-hydroxy vitamin D levels are checked yearly in all nonambulatory children with CP seen in our program. We have found many children who are insufficient and some who are overtly deficient.
This MOC project brings more focus to bear on the conduct of the QI effort and involves all of our faculty, nutritionists, nurses and nurse practitioners. The goal of the project is to increase the number of children who get an annual vitamin D level and to increase the percentage number of children with sufficient levels. Together with other efforts, we intend to lower the rate of low-impact fractures in this population.
This QI project is adaptable to other clinic settings here at Seattle Children's and elsewhere.
To participate or to discuss adapting this project to your program, contact the project leaders, Dr. William Walker and Dr. Dan Doherty.
Assuring Vitamin D Sufficiency in Children with Epilepsy
Children living in the Northwest are at risk for low vitamin D levels due to their geographic location. In particular, children with epilepsy are at higher risk for vitamin D deficiency and low-impact fractures due to multiple factors including ambulatory status, nutritional intake and use of medications that interfere with vitamin D metabolism, among others. This project is designed to monitor and improve vitamin D insufficiency/supplementation in patients visiting Seattle Children’s Neurology Clinic and taking antiepileptic medications for seizures.
Participation in this project is limited to faculty in Seattle Children’s Department of Neurology.
To participate, contact the project leader, Dr. Sidney Gospe.
Clinical Standard Work (CSW) Projects in Improvement
The goal of this project is to improve adherence to recommendations in Seattle Children’s Clinical Standard Work (CSW) pathways. The development, implementation and improvement of each pathway is led by a physician and a consultant from the Clinical Effectiveness team. Each pathway has specific process/adherence metrics that have been identified as critical to the implementation of a care bundle. Participants in this MOC project will focus on one of seven measures for pathway recommendations categorized into the following seven areas: medication appropriate usage; laboratory utilization; radiology appropriate usage; education and training compliance; checklist/documentation adherence; timeliness of therapy; and orderset/powerplan adherence.
Participation in this project is limited to CSW owners, co-owners, and clinical effectiveness consultants.
For more information, please contact Dr. Howard Jeffries and Dr. Jeff Foti.
Cyclophosphamide Recurring Infusion Pathway Practice Improvement (CRIPPI)
Cyclophosphamide is a potentially toxic medication used for treatment of severe disease in pediatric patients with inflammatory disorders such as systemic lupus erythematosus and systemic vasculitis. Patients are at risk for short-term complications that can occur during the cyclophosphamide infusion, as well as long-term complications related to cumulative cyclophosphamide doses and concomitant corticosteroid administration. The Clinical Standard Work Cyclophosphamide Recurring Infusion Pathway is a Seattle Children’s Hospital evidence-based quality improvement effort developed to optimize clinical efficacy of cyclophosphamide and minimize possible adverse events associated with this treatment regimen. This MOC project aims to improve adherence to three specific pathway recommendations:
- To utilize minimally effective cumulative cyclophosphamide dose by using recommended starting dose range
- To provide outpatient prescription for calcium and vitamin D supplementation to all patients on the pathway
- To screen for pregnancy prior to each cyclophosphamide administration in female patients >12 years
To participate, contact the project leader, Dr. Kristen Hayward.
Head CT Utilization Pediatric Head Trauma
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.
To participate, contact the project leader, Dr. Rebecca Jennings.
Hepatitis B Newborn Immunization Rate
The AAP recommends giving infants the first hepatitis B immunization during the postpartum period to help decrease perinatal transmission. Challenges to adhering to this national recommendation include vaccine misinformation; fear of immunization that arises after birth; fear of lack of documentation of immunizations by primary care physicians; and fear of over-immunization, as hepatitis B is included in several combination immunizations.
We seek to improve immunization rates by approaching families for vaccine consent upon maternal admission during labor and administering hepatitis B immunization at the same time as vitamin K. We will also seek to understand other reasons for vaccine hesitancy and develop further approaches to overcome the reluctance to routine immunizations.
To participate or to discuss adapting this project to your program, contact the project leader, Dr. Carlos Villavicencio.
Implementation of Pulse Oximetry Screening for Critical Congenital Heart Disease
A recommendation for universal pulse oximetry screening for critical congenital heart disease of all newborns in the well-infant or intermediate nursery was issued in fall 2011. Previously, pulse oximetry was not a part of standard newborn care so birth hospitals have had to develop and implement new protocols. The main goal is to assure that all eligible newborns are screened with pulse oximetry. Additional challenges include assuring high-quality screening, as measured by whether false positive rates are consistent with the literature; assuring that appropriate responses to abnormal screening results are performed; and effective communication of screening results to outpatient providers who will be seeing the newborns in follow-up.
To participate, contact the project leader, Dr. Amy Schultz.
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.
To participate either individually or as a clinic/program, contact the project leaders, Dr. Matthew Kronman and Dr. Annika Hofstetter.
NICU Handoff Improvement
Communication and handoff failures contribute to two thirds of serious and preventable adverse events in hospitals (“sentinel events”). The goal of this MOC project is to develop, implement and continually improve a reliable NICU attending handoff process that will improve communication and patient safety for infants who require intensive care. Participants will learn the best practices for handoffs, collect data on critical information omitted during handoffs, provide just-in-time feedback during handoffs and identify and mitigate improvement barriers.
Participation in this project is currently limited to attending neonatologists at Seattle Children's Hospital and the University of Washington Medical Center.
To participate, contact the project leaders, Dr. David Loren (UWMC) or Dr. Craig Jackson (Seattle Children's).
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.
To participate, contact the project leader, Dr. Linda Wallen.
Reducing Central Line–Associated Bloodstream Infection (CLABSI)
Central line–associated bloodstream infection (CLABSI) is a common healthcare-associated infection and is associated with significant morbidity and mortality. At Seattle Children’s Hospital, we have developed a hospital-wide quality improvement project called Reducing Central Line–Associated Bloodstream Infection. This project aims to reduce CLABSI by standardizing insertion and maintenance of central venous catheters. MOC-associated projects include:
- Improving online documentation of central line placement and use of the infection prevention bundle by all providers placing central venous catheters
- A trial of prophylactic ethanol lock therapy in patients hospitalized with AML or relapsed ALL
To participate, contact the project leader, Dr. Danielle Zerr.
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.