ABSTRACT
Bullying annually affects 20%-25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months. Methods: Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5-18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners. Results: The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health. Conclusions: Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.
ABSTRACT
Communication and patient education are key to effective healthcare encounters and improved health outcomes. The after-visit summary (AVS) is an integral communication and education tool for patients and families. Without effective communication, gaps in comprehension may result in decreased satisfaction with medical encounters, lack of adherence to recommended treatment plans, missed appointments, and increased malpractice claims. Methods: We initiated a quality improvement (QI) initiative implementing concepts derived from the Institute for Healthcare Improvement (IHI) model, including plan-do-study-act cycles, to increase AVS distribution rates in a high-volume, fast-paced ambulatory pediatric orthopedic clinic. Interventions included staff education and training, trainee instruction, enlistment of electronic medical record superusers to enhance the distribution process, and provision of regular, transparent communication of individual and team performance. The impact of interventions was measured using a p-chart. Results: There was a consistent improvement in the rate of AVS distribution with each intervention implemented. The distribution rate on project initiation was 81.9%, with a final rate of 95.7%. The most statistically significant shift occurred following the final intervention, which included sharing unblinded individual performance data. Conclusion: Our data demonstrate that a dedicated QI program using IHI methodology improved AVS distribution rates in a pediatric orthopedic clinic. Consistently distributing the AVS affords our patients and families a better opportunity to review pertinent visit information, education, medication changes, and upcoming appointments.
