A B S T R A C T OBJECTIVES:(1) To implement a new policy-driven referral program, Opt-to-Quit, using electronic data transfer from the electronic health record (EHR) to the New York State Smokers' Quitline (NYSSQL) and (2) to improve referrals to the NYSSQL for smoking caregivers of children admitted to a children's hospital. METHODS:Smoking caregivers of pediatric patients were referred to the NYSSQL through a standardized template built into the EHR, during the child's hospitalization or emergency department encounter. Direct data exchange was based on a point-to-point protocol, without dependence on any external centralized processing service. Input and oversight were provided by a multidisciplinary task force, which included physician and nursing leadership, information technology specialists, Health Insurance Portability and Accountability Act compliance personnel and legal counsel, and NYSSQL staff. The process was refined through several iterative plan-dostudy-act cycles, using a single-armed, prospective cohort study design, including surveys of nursing staff and continued input of information technology experts on both hospital and Quitline sides. RESULTS:In 2013, 193 smokers were identified in 2 pilot units; 62% (n5 119) accepted referral to the NYSSQL. In 2014, after expansion to all inpatient units and the emergency department, 745 smokers were identified, and 36% (n 5 266) accepted referral. Over the 2 years, overall increase in referrals was 124%; as of the first quarter of 2015, referral rate was sustained at 34%. CONCLUSIONS:Hospital-wide implementation of the Opt-to-Quit program through our EHR was feasible and sustainable and has significantly improved referrals to the NYSSQL. POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential conflicts of interest to disclose.Dr Boykan initiated the implementation of the Opt-to-Quit program at Stony Brook Children' s Hospital, oversaw data collection and analyses, and contributed to, reviewed, and revised the manuscript; Dr Milana oversaw data collection and analyses and contributed to, reviewed, and revised the manuscript; Ms Propper oversaw data collection and analyses, directed process change at Stony Brook Children' s at all stages of this initiative, and contributed to, reviewed, and revised the manuscript; Ms Bax and Ms Celestino directed the implementation and all process changes at the New York State Smoker' s Quitline and contributed to, reviewed, and revised the manuscript; and all authors approved the manuscript as submitted.HOSPITAL PEDIATRICS Volume 6, Issue 9, September 2016 545by guest on May 10, 2018 http://hosppeds.aappublications.org/ Downloaded from Smoking rates have significantly decreased over the past 20 years. Despite advances, 14.5% of adults in New York State are smokers, and more than 1 000 000 children are exposed to secondhand smoke (SHS) each year.1,2 Physicians and other health care workers play an important role in promoting evidence-based smoking cessation treatments, such as motivational intervi...
INTRODUCTION:Sepsis left untreated can lead to severe sepsis, septic shock, and death. For patients who escalate to severe sepsis, prompt recognition and timely initiation of standardized treatment bundles leads to improved outcomes. We sought to develop a unique real-time automated severe sepsis alert to notify physicians directly via the electronic medical record (EMR) and the paging system. Our goal was to identify and rapidly treat pediatric patients with severe sepsis in our ED and inpatient units. Our SMART AIM was to reduce mortality due to sepsis by improving one-hour bundle compliance by 30% within 2 years of implementing the electronic severe sepsis interruptive alert. METHODS:Criteria for the alert were developed by our interdisciplinary team and were based on the 2005 International Pediatric Consensus definitions. If SIRS criteria were met with organ dysfunction based upon vital signs and lab results in the EMR, an interruptive alert will appear upon opening that patient's chart and a notification page will be sent to an attending physician, who evaluates the patient and initiates treatment as warranted. Response to alert and documentation is required. Prior to alert roll-out, educational sessions were conducted. Accuracy of alert fires, physician compliance with answering alert, event documentation, and bundle compliance were monitored. PDCA cycles were performed along with ongoing education. RESULTS:Baseline data on completion of all bundle elements (one hour to obtain blood cultures, initiate antibiotics and fluids) for 2016 and 2017 were 23% and 50% respectively. Our electronic alert went live in 2018. Bundle compliance rose to 65% in 2019 then to 71% in 2020. Our sepsis mortality rates have dropped to a mean rate of 8% over the last three years, a rate significantly lower than the Vizient top 20 pediatric hospitals rate of 11.7%. CONCLUSIONS:An automated, interruptive severe sepsis screening alert sent directly to providers is a valuable tool to ensure prompt severe sepsis recognition and treatment, decreasing sepsis mortality. We attribute this success to prompt recognition leading to earlier initiation of treatment. Additionally, we appreciated improved communication between all team members. Future directions include developing a tool applicable to the neonatal ICU and the newborn nursery.
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