By John Weaver, MD, Urology Fellow
The Division of Urology at Children’s Hospital of Philadelphia constantly evaluates the care we deliver to our children. We constantly identify areas where we can improve. As part of this process, we take a detailed look at our care and, using outcomes data, find areas where we can institute practical quality improvement projects.
Over the past year we have implemented several new protocols to help better understand and address our division’s readmission rates, reoperation rates, and time to the operating room for testicular torsions.
Specific actions we took include:
- Creating an automated algorithm that identifies reoperations and readmissions from the electronic medical record. The algorithm compiles the number of reoperations and readmissions over the course of each month, and that data is then sent via an automated e-mail to all attending physicians in the division.
- Creating an automated algorithm that identifies testicular torsion occurrences. Each month a complete list of the testicular torsions seen at our institution and their times to the operating room is automatically compiled and distributed to the faculty.
- Having a pediatric urologist view and verify the accuracy of each instance. A small, appointed working group of pediatric urologists and administrative faculty meet monthly to review these e-mails and identify any events that may be modifiable and discuss potential interventions amongst the group.
- Meeting semiannually as a division. During this meeting, results from the prior six months are reviewed with the entire division, and any actions to decrease any of these metrics are discussed in detail and implemented.
This process has already led to improvements. One example: we are tailoring our use of antibiotics to target high-risk boys and girls at risk for infection while simultaneously minimizing our antibiotic use in children who are at low risk. The majority of patients we care for fall into the low-risk category and minimizing our use of antibiotics in this group is resulting in decreased antibiotic resistance. Tailored use in the high-risk cohort is resulting in fewer preventable readmissions.
In the future we hope to further risk stratify this high-risk population through a more detailed examination of high-risk procedures. Indwelling hardware in the urinary tract following endoscopic procedures is our current area of focus.
Our hope is that these quality improvement measures will decrease the overall morbidity experienced by all our patients. We will assess this over time with a drop in readmissions and reoperations.