Attempting to Define Clinical Productivity Metrics among Pediatric Palliative Care Services at Academic Children's Hospitals.

Introduction: Pediatric palliative care (PPC) programs have grown in size and number at academic children's hospitals in the United States for the past 20 years. Little is known about the relationships between program workforce staffing, billing and coding practices, clinical service requirements for billing providers, and sustainability of program models for billing providers. Methods: The authors contacted a convenience sample of 10 PPC program leaders at academic children's hospitals in the United States. Program leaders were asked to provide information about billing provider full-time equivalent (FTE) staffing, billing and coding practices, and productivity metrics for a three-month period, from January 1 to March 31, 2017. Results: Ten programs participated in the convenience sample survey, and seven provided information about billing and coding practices. For the seven programs that provided evaluation and management data, calculated estimate of mean work Relative Value Unit (wRVU) production per 1.0 FTE per year was 1626. Calculated estimate of consultations per 1.0 FTE per month was 15. Calculated estimate of total clinical encounters per 1.0 FTE per month was 70. Conclusions: The relationships between PPC billing provider productivity and clinical workload are complex and vary widely among a convenience sample of academic PPC programs. Given the high burnout rates in the field, efforts should be made to more clearly define these relationships to promote sustainability of both billing and nonbilling PPC providers.

Peer-Debriefing After Distressing Patient Care Events: A Workshop for Pediatric Residents.

Introduction: When confronted with a distressing patient care event, physicians experience feelings of failure, inadequacy, and self-doubt that negatively impact emotional well-being and have been linked to burnout and premature exit from the medical profession. A need exists within the medical community for improved emotional processing of distressing patient care events, particularly for resident physicians at the beginning of their careers. Methods: To encourage physicians to communicate as a means of initiating emotional processing after a distressing patient care event, a workshop was developed for pediatric residents providing training on a peer-debriefing model taken from the bereavement counseling literature. The workshop is designed to take 60 minutes, including dedicated opportunities to observe and conduct debriefing sessions based on the residents' own distressing patient care experiences. Included are the workshop facilitation guide, the adapted peer-debriefing model, hypothetical patient care scenarios, and pre- and postsession survey evaluation forms. Results: Pre- and posttraining survey metrics revealed statistically significant and meaningful increases in pediatric residents' self-reported comfort with and likelihood of leading a peer-debriefing session in an appropriate clinical setting. Discussion: This workshop is a well-received, effective intervention that provides pediatric residents with a tool to aid in the timely emotional processing of distressing patient care events. It has been adopted into the standard educational curriculum of our home institution's pediatric residency program. This workshop may be extended throughout the field, helping physicians at all levels of practice process the inevitable distress inherent in caring for the sick.

Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals.

In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings. The hospitals we interviewed achieved a culture of quality by: 1) developing guiding principles that foster quality; 2) hiring and retaining personnel who are stewards of quality; 3) promoting efficient resource utilization; 4) developing a well-organized quality improvement infrastructure; and 5) cultivating integrated, patient-centric care. The institutions highlighted in this report provide important lessons for MLKCH and other safety-net institutions.