With a shared purpose of improving child health, children's hospitals and health systems regularly come together to discuss experiences, solve problems, and stay current on the top issues impacting pediatric health care. Within their conversations in 2024, common threads have emerged. These trending topics are top-of-mind as hospitals seek to improve care and operations.
Perennial issues like CLABSIs continue to challenge hospitals, and they're approaching these infections from different vantage points and with new tools. Emerging technology like AI offers opportunities to boost efficiency and improve care, and hospitals are eager to discover how to make the most of it. Recent trends in inpatient and ED demographics are causing increased concern with violence against staff. The continuing mental health crisis has urged hospitals to screen for mental health conditions in non-traditional settings. A focus on making care more equitable has spurred new kinds of metrics and data analysis to accurately understand the populations hospitals serve.
See how children’s hospitals are addressing these topics common among CHA members and the promising results so far.
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Mental health screenings
Facing a mental health crisis among young people, children’s hospitals are increasing suicide and depression screenings to connect kids with resources sooner.
Universal screening
In 2021, Children’s Wisconsin set out to implement a universal suicide screening process across the health system. In two years, more than 27,000 Ask Suicide-Screening Questions (ASQ) screenings were conducted, resulting in more than 400 social work consults. Patients who score in the non-acute positive range on the ASQ are additionally screened using the Columbia Suicide Severity Rating Scale to help triage their level of risk. Children 10 and older are screened every 30 days within the health system.
Specialty clinic screenings
Atrium Health Levine Children’s Hospital incorporated GAD-7 and PHQ-9 screening tools into the routine workflow at a pediatric nephrology clinic, aiming to increase recognition of anxiety and depression in patients over 12 years old who have chronic conditions. Eighty percent of eligible patients were screened at their clinic visit, and 80% of those patients with a score greater than or equal to five received an intervention. Upon rescreening, 64.5% had decreased GAD-7 anxiety scores and 61% had decreased PHQ-9 depression scores. To better individualize interventions, the team added three questions to the original GAD-7 screening. Additionally, a multidisciplinary team developed a stepped intervention protocol for anxiety and depression depending on scores.
Emergency department screenings
Children’s Hospital of Philadelphia instituted a routine behavioral health screening of every adolescent in the emergency department. They co-designed a new screening tailored specifically to ED patients, integrating it with the EHR and a web-based software platform, and developed multifaceted interventions for positive screens. More than 300 behavioral health screens are completed each month in the ED, with approximately one-third of screenings revealing symptoms of moderate to severe depression or suicidal ideation.
Workplace violence
Violence in the workplace is a growing concern for children's hospitals. According to a survey published in the Journal of Pediatric Nursing, 73% of respondents experienced one or two violent situations on their unit in the previous 12 months.
Care pathways and processes
A specialized care pathway for patients with autism spectrum disorder (ASD) reduced workplace violence events by nearly 50% while decreasing behavioral health stays by 19 days at St. Louis Children’s Hospital. The hospital also added psychiatrists and advanced practice providers, identified “preferred” inpatient rooms and removed potential hazards such as blind corners and countertops, increased staff education, and uses the Broset Violence Checklist (BVC) to identify escalated events before they become critical.
The pathway includes:
- A behavior plan, including known triggers and de-escalation strategies, in the electronic medical record.
- Flags in the EMR that indicate the patient has a history of violence.
- Twice daily huddles and a weekly huddle to identify barriers to discharge.
- Consistency among caregivers, therapists, and schedules.
- Environmental risk assessments.
Clinical debriefs
To reduce second episodes of violence in behavioral health patients, Children’s Hospital of the King’s Daughters launched a clinical debriefing process. After events where physical restraints are used, the bedside nurse, behavioral health care providers, and all other staff members involved in the incident gather for a 5-to-10-minute meeting. The blame-free debrief follows a script with a few questions based on the plus-delta model for clinical debriefing. The clinical debriefs led to a 67% reduction in physical restraint episodes in ED patients. Further, the total time that restraints were used for all ED patients dropped from nearly 15 hours per 1,000 hours of ED care to less than three hours—a reduction of 82%.
Toolkits and checklists
Monroe Carrell Children’s Hospital at Vanderbilt uses the Broset Violence Checklist to reduce employee days away, restricted, or transferred work duties (DART). A behavioral health toolkit developed by the hospital resulted in 618 days without a DART event.
The toolkit has five components:
- Checklist. Identify escalation using the Broset Violence Checklist.
- Orders. Enter individualized admission orders based on a patient’s needs.
- Triggers. Ask the patient or family member to identify specific triggers and preferences.
- Comfort. Give patients access to coping or comfort items.
- Visibility. Share patients’ behavioral plans across all disciplines.
CLABSIs
For decades, children's hospitals have worked to eliminate central line associated bloodstream infections (CLABSI), continually refining their efforts as knowledge and technology improve. Now they are addressing the age-old problem from new vantage points, through machine learning, and with more diligence.
Zero disparities
Seattle Children's eliminated CLABSI disparities for Black patients and patients who use a language other than English by stratifying data by race, ethnicity, and language; establishing a specialized role dedicated to central lines; and improving translated education for families. The interventions not only eliminated the disparities but also reduced the CLABSI infection rate for hospitalized patients across all groups.
Predictive dashboard
Riley Children’s Health created a predictive dashboard to identify patients most likely to develop a hospital-acquired condition. It also identified opportunities to reduce lines overall. The dashboard predicts the risk of CLABSIs, hospital-acquired pressure injuries, and catheter-associated urinary tract infections based on documented risk factors in the EMR, such as chlorhexidine gluconate baths, dressing and linen changes, number of times the line is accessed, total number of lines, and more. The dashboard drove a 35% reduction in CLABSIs.
332 days
After discovering 75% of NICU CLABSIs occurred on double lumen central lines, Children’s Mercy Kansas City began using them only when medically necessary. They also reduced the total use of central lines, required parent handwashing, conducted multi-disciplinary rounds several times a day, and created a nurse group chat to stay informed about central line patients. At Inova L.J. Murphy Children’s Hospital, staff observed and discussed daily operations across departments, created a multi-disciplinary team that met regularly to identify improvements, made daily device rounds, and educated patients about hygiene practices. The interventions led to 332 days without a CLABSI at both hospitals.
Top themes
Most CLABSI success stories include these four elements.
- Multidisciplinary teams. Staff from technicians to physicians to environmental services meet regularly to review events and identify areas for improvement.
- Hygiene. Parents and patients are required to wash hands and are educated on hygienic practices.
- Rounds. Teams round on units multiple times a day to observe patients, operations, and devices.
- Data. Accurate and comprehensive data enables more equitable, effective metrics that lead to prevention.
Cybersecurity
Here are five tips from chief information officers to help safeguard networks and patient information:
- Educate staff against phishing.
- Continuously manage and audit vendor risk.
- Segment devices and networks.
- Require multi-factor authentication.
- Build relationships with other IT professionals.
REaL Data
Children’s hospitals are seeking ways to improve the accuracy of race, ethnicity, and language (REaL) patient data. Capturing this demographic data allows health care organizations to better understand patients’ and caregivers’ lived experiences, quantify equity gaps, address bias in processes, policies, and behaviors, use effective communication, and track the success of interventions.
Accurate REaL data collection may be hindered by limitations in hospitals’ electronic medical records, patient and caregiver hesitancy, and inconsistencies in race and ethnicity definitions. Here what children’s hospitals should consider when working to improve REaL data collection.
- Build data collection into quality improvement efforts.
- Align with diversity, equity, and inclusion initiatives.
- Engage patient and community groups.
- Use scripting and provide a way for caregivers and patient to self-report information.
- Include options for multiple languages, races, and ethnicities.
- Track and report progress on an organization-wide basis.
- Match REaL data collection efforts with existing governmental reporting requirements.
- Assign accountability for improvements.
- Employ standardized policies and trainings across the entire organization.
Artificial intelligence
As science fiction becomes simply science, children’s hospitals are adapting to the seemingly infinite possibilities of artificial intelligence.
Genetic syndrome diagnosis
A noninvasive AI solution at Children’s National Hospital assesses the structure of a patient’s face for specific feature attributes associated with genetic disorders.
Transplant matches
At Cincinnati Children’s, an open-source AI tool enables cardiologists to make heart transplant matches in seconds.
Readmission predictions
An AI model at Akron Children automatically produces a deterioration index score indicating a patient’s risk factor and populates a graph illustrating the patient’s trendline over time — allowing the care team to intervene early.
Error detection
An application at Boston Children’s Hospital identifies and alerts critical findings in provider notes and reports, highlighting potential medical errors in medication orders.
Diagnosis and prediction
An AI data platform used by Phoenix Children’s automatically diagnoses patients with malnutrition, predicts no-show appointments, and accurately anticipates emergency department volume.
