Children’s Hospital of Orange County (CHOC) received the 2021 HIMSS Davies Award, making it the first pediatric hospital in North America to be named a Davies Award recipient for the second time.1
The Davies Award recognized the hospital’s work to reduce readmissions; improve pediatric asthma access, care and outcomes; and increase proper handling of human milk and formula for infants.
“I am so proud to be associated with such a great organization and great group of people so focused on improving the quality and safety of the care we provide,” said Bill Feaster, MD, vice president and chief health information officer.
To be considered for the award, CHOC leaders submitted three in-depth case studies showcasing their measurable and sustained improvements. Further details on the three case studies can be found on the HIMSS website.
Readmission rate risk predictor
CHOC leadership looked for ways to reduce the unplanned readmission rate at the hospital, as unplanned readmissions are closely tied to quality of care. Utilizing machine learning and HealtheDataLabTM, CHOC created a predictive model to help determine which patients are likely to be readmitted. With the HealtheDataLab cloud-based environment, the team could include more risk factors in their model and analyze the data faster.2
“We were able to discover additional variables with the help of the solutions for data access in HealtheDataLab. We translated those findings into the final model deployed for readmission,” said Louis Ehwerhemuepha, PhD, senior data scientist, information systems.
The model assigned a readmission probability score to each patient based on how high of a risk they were to be readmitted, and this score was input into the electronic health record (EHR). The clinical teams utilized the score to identify those with high, moderate and low risk, who received daily assessment from admission to discharge to observe for and target any necessary interventions as well as plan for follow-up, post-discharge. They also evaluated factors that could lead to readmission and worked to prevent them.
CHOC looked at both readmission rates for seven-day and 30-day metrics. After years of maintaining an average seven-day unplanned readmission rate around 4%, the organization decreased the unplanned readmission rate to about 3% with the utilization of the near real-time readmission predictive score. More specifically, in 2013, the seven-day readmission was 3.8%, and the 30-day rate was 12.3%. In 2019, however, after implementation of the near real-time tool, the readmission rate was 3.3% and 11.0% for seven- and 30-day rates, respectively.3
Sustainment of a successful pediatric asthma management program
In 2016, CHOC earned its first HIMSS Davies Award for a case study that focused on reducing the average length of hospital stays for pediatric asthma patients. In 2017, the organization worked to expand and sustain their program around pediatric asthma patients with a stronger focus on improving and standardizing the ambulatory care component. The primary goal was to demonstrate a decrease in ED visits and hospital admissions as a proxy for improved quality.
With the help of HealtheIntent® and HealtheRegistriesSM, CHOC clinicians developed processes to create standard workflows, regardless of provider or location, and to identify patients with asthma who required an asthma action plan (AAP) and asthma control test (ACT), interventions that enhance patient control and prevent asthma exacerbations and the need for emergency care. They also created a pediatric asthma registry that can be utilized across the continuum of care.
“By standardizing care around evidence-based recommendations and making actionable, timely data readily available at the point of care, we were able to engage our providers and staff in a significant cultural change that benefitted both the patients and the staff,” said Mike Weiss, MD, vice president, population health.
CHOC saw several metrics improve following the implementation of HealtheIntent. In December 2019, about 59% of primary care patients received the pediatric AAP, up from 28.89% in April 2017. Additionally, 57% of primary care patients received the ACT in December 2019, up from 29.61% in April 2017. Lastly, patients being seen in the emergency department for asthma decreased, as well as the readmission rate within seven days of discharge per 100 discharges decreased from 1.84 to 0.3.4
Infant feeding and enteral feeding safety
According to the Centers for Disease Control and Prevention, human milk is not only the best source of nutrition for most infants, but it can also reduce the risk for a variety of short- and long-term health conditions for both infants and mothers.5 Expressed human milk, particularly if it has been fortified with additional nutrients, requires proper handling, storage, and labeling to prevent contamination and misadministration. Improperly labeled or expired bottles could potentially lead to negative health outcomes, especially for premature infants. The same principles also apply to specialty formulas received by hospitalized infants and older children.
The CHOC team focused on improving patient safety by eliminating identification, preparation, and feeding errors through a human milk and formula tracking solution that integrated with the Cerner EHR. The solution helped make sure the correct human milk, additives, or formulas were being used at the time of preparation and tracked lot numbers and expiration dates on all items. Scanning at the bedside before feeding helped deliver the right feeding to the right patient at the right time. CHOC also worked with staff to fortify hygiene standards while handling infant and enteral feedings and created a dedicated preparation location with dedicated technicians.
“The addition of human milk and formula scanning helped improve safety for our patients,” said Caroline Steele, MS, RD, CSP, IBCLC, FAND, former director, clinical nutrition & lactation. “It allowed us to assist in making sure every component matched the provider order and to track lot numbers and expiration dates for hundreds of feedings per day while calculating complex feeding recipes, helping reduce the risk of human error. This level of tracking and monitoring would be logistically impossible through manual processes.”
Incorrect milk fed prior to the changes in 2012 decreased from three to zero in fiscal year (FY) 2019 and remained at zero through FY 2020, despite expressed human milk volumes increasing by 36% since FY 2015 (potentially helping to increase the risk of errors). Furthermore, the ability to scan all additives and products to compare to the provider order offered additional protection and tracking not previously available.6
1 “Children’s Hospital of Orange County Earns Second Davies Award,” HIMSS: https://www.himss.org/news/childrens-hospital-orange-county-earns-second-davies-award
2 The algorithm was created in collaboration between Cerner and CHOC, which was a pilot group for HealtheDataLab.
3 “Readmission Rate Risk Predictor Case Study,” HIMSS: https://www.himss.org/resources/readmission-rate-risk-predictor-case-study
4 “Sustainment of a Successful Pediatric Asthma Management Program Case Study,” HIMSS: https://www.himss.org/resources/sustainment-successful-pediatric-asthma-management-program-case-study
5 “Breastfeeding Frequently Asked Questions (FAQs),” Centers for Disease Control and Prevention: https://www.cdc.gov/breastfeeding/faq/index.htm#:~:text=Breast%20milk%20provides%20the%20best,(not%20recommended)%20while%20breastfeeding.
6 “Infant Feeding and Enteral Feeding Safety Case Study,” HIMSS: https://www.himss.org/resources/infant-feeding-and-enteral-feeding-safety-case-study