Health System Transformation and Leadership Distinction (cid:32) Track Program Mentors

PURPOSE/OBJECTIVES: Bronchiolitis is an acute lung disease that causes inflammation and congestion of the small airways. It is a common respiratory disease seen most severely in children under 2 years old. Regarding treatment, the American Academy of Pediatrics recommends supportive therapy with hydration maintenance, respiratory support, and supplemental oxygen for hypoxemia. High flow nasal cannula (HFNC) has been used for children with bronchiolitis, significantly decreasing the work of breathing and preventing the need for escalation of care. Studies have shown that the use of HFNC decreases rates of intubation and mechanical ventilation. AIM: The purpose of this study is to show that the use of a new HFNC policy allowing higher flows outside the Pediatric Intensive Care Unit (PICU) for respiratory support of patients with bronchiolitis up to two years of age, results in at least a 25% reduction in transfers to the PICU, and decreases average patient length of stay. METHODS: Fifty patients age ≤ 24 months admitted for bronchiolitis to the general ward were identified in the pre-intervention period (January-March 2019) and 52 patients were identified in the post-intervention period (January-March 2020). In the pre-intervention period, 11 patients received respiratory support on HFNC. In the post-intervention period, 33 patients were on NC, 19 on HFNC. RESULTS: Although HFNC use was more common in the post-intervention period, this difference did not reach statistical significance (p=0.107). Fewer patients in the post-intervention cohort required admission to the PICU (26% vs. 55%, p=0.122). Median hospital length of stay was shorter post-intervention (3 vs. 5 days) and the maximum Pediatric Early Warning Score was lower post-intervention (median of 6 vs. 7 points), (p=0.066 and p=0.081, respectively). CONCLUSION/DISCUSSION : There is no increase in escalation of care requiring transfer to PICU in patients ≤ 24 months old with bronchiolitis using the new HFNC policy. The results of this project support the use of higher flows (1.5L/kg/min) in the general pediatric floor for this patient population. There was a 31% reduction in transfers to the PICU because of this new policy. Although the findings for this study were useful for making clinical decisions, some of the results were not statistically significant, likely due to a smaller sample size. COVID-19 limited this study; additional cycles were planned for 2021 RSV season, but were unable to be completed as pediatric admission numbers fell. Introduction: Foot ulcers are one of the most common complications of diabetes and can result in infections, deformities, and amputations. If performed annually, using a Semmes-Weinstein 5.07/10-gram monofilament, the diabetic foot exam can clue providers into sensory changes that contribute to the formation of ulcers. The ECU Med-Peds Clinic is an academic practice with 29 providers, where a quality improvement project focusing on increasing the completion and documentation of the diabetic foot exam was implemented from March 2021 to March 2022. This project aimed to have 70 percent of patients with diabetes have documentation of a received foot exam in the past one year. Methods: The project involved plan-do-study-act cycles to optimize the clinical workflow and completion of the foot exam. The outcome measure was the percentage of documented foot exams, obtained from the electronic medical record (EMR). Initially, an anonymous survey was sent to all providers to identify reasons why the foot exam was not completed. Various ECU clinics were visited to see what effective interventions had been employed. First, monofilaments were placed in a readily accessible and visible location, in addition to replacing broken/missing ones. The second intervention focused on providing a 30-minute education session in the clinic on how to perform the foot exam and document it in the EMR. Lastly, a chart review was performed for the 898 patients that did not have a documented foot exam in the past year. These patients subsequently were scheduled for an appointment to receive their exam. Results: The initial survey given to providers yielded a 60 percent completion rate. The most cited reason for not completing a foot exam was a lack of monofilaments in the rooms. Initially, the clinic was at a 68% foot exam completion rate, which decreased to 60% three months after replacing the monofilaments and increasing visibility. Three months after the education session, the completion rate decreased to 59%. After PDSA three, the rate decreased to 55%. Conclusion: Despite the interventions that have been employed, the percentage of documented foot exams continues to Background: The 2020 American Diabetes Association (ADA) Standard of Medical Care in Diabetes for Children and Adolescents recommends that initial therapy for overweight/obese patients with new onset diabetes appropriately address metabolic derangements. The guidelines also suggest that, for a subset of patients, less intensive therapy initiated in the outpatient setting may achieve target HgbA1c. Historically, our center hospitalized most patients with new onset diabetes and initiated full basal/bolus (intensive) insulin regardless of initial labs and likelihood of Type 2 Diabetes (T2D). Objective: We implemented a standardized protocol for the initial management of overweight/obese patients 10 to 17 years of age with new onset diabetes to align our practice with the 2020 ADA recommendations, with the goal of decreasing hospital admission rates and use of intensive insulin. Methods: A treatment protocol was developed based on initial labs. The protocol was retrospectively applied to patients with T2D seen in clinic to determine the expected change in admission rates and use of intensive insulin. Beginning June 2020, Plan-Do-Study-Act cycles were utilized to implement the protocol prospectively, while monitoring admission rates at diagnosis and the percentage of patients initially managed by one of five treatment regimens defined by escalation of insulin therapy. Results: Our retrospective review revealed a 67% admission rate at T2D diagnosis with 66% of patients receiving intensive insulin. In this cohort, the new protocol would have implied a reduction in admission rates to 40% and intensive insulin use to 20%. Following implementation of the protocol with adherence rates improving from 68% to 94%, the median quarterly admission rate between June 2020 and March 2022 was 53%, with 44% of patients receiving intensive insulin therapy. Preliminary data review suggests similar average HgbA1c levels between 7.7% to 8.5% for all treatment groups except for diet and lifestyle at the 6 - 9 month follow-up mark. Background: The American Academy of Pediatric Dentistry, the American Dental Association, and the American Academy of Pediatrics recommend that children establish care with a dentist before their first birthday or within six months of the eruption of their first tooth. Routine dental care has been shown to decrease morbidity, mortality, and overall cost of care. The Baby Oral Health Program (BOHP) is a partnership between the East Carolina University (ECU) Pediatrics Outpatient Center (OPC) and the ECU School of Dental Medicine (SoDM) that established a direct referral process for children without a dental home. The specific aim of this study was to improve the percentage of patients referred through the BOHP who establish a dental home to 75% within 1 year. Methods: Stakeholder input was sought through surveys and interviews to identify barriers to the establishment of a dental home. Process flow and fishbone diagrams were created to represent identified areas of improvement. Design cycles were created and implemented to target these defined areas. Data on BOHP referrals were retrospectively reviewed to determine the percentage of patients referred who scheduled a first visit with the SoDM clinic. Other measures included the turnaround time (days) between initial referral and contacting the patient via phone and appointment wait time (days). Results: At baseline, 61% of BOHP referred patients established a dental home with ECU SoDM. Identified areas of improvement included increased usability of the referral form and improved provider and parent education on the referral process. Referral form shortfalls included the need for multiple patient phone numbers for follow-up and a Spanish version. At initiation of this project, 13/13 (100%) of attending physicians, 13/21 (62%) of pediatric residents, and 0/5 (0%) of medicine-pediatric residents surveyed were aware of the BOHP. To date, electronic medical record (EMR) technical difficulties and personnel turnover has made collection of design cycle data unfeasible. Conclusions: Previous projects have described improved pediatric dental care compliance Introduction: Use of Emergency Medical Services (EMS) in the activation of hospital-based protocols is crucial in time sensitive scenarios. Early recognition of ST Elevation Myocardial Infarction (STEMI) is integral to improved outcomes in patient care. Studies have shown that pre- hospital activation of STEMI is associated with shorter “door -to- balloon” times in emergent percutaneous coronary intervention (PCI). Currently there remains a divide between the emergency prehospital systems and the emergency room itself at Vidant Medical Center (VMC). Both diagnostic accuracy and adequate communication mechanisms are necessary to bridge this gap between the two integral systems. In this study we aim to identify the barriers involved in delayed STEMI activation within VMC and seek to address barriers to activation within the Pitt County EMS System through improving electrocardiogram (EKG) diagnostic accuracy among EMS personnel and identifying challenges within the varying modes of communication between the hospital and incoming ambulances. Methods: Improper activation rate was determined by ma