Title: Detection and Prevention of Pre-analytic Errors in the Clinical Laboratory
ABSTRACT
Project Leads:
David Shimabukuro MD, SICU Medical Director
Elena Nedelcu MD, Assistant Medical Director, Transfusion Service
Executive Sponsor: Mitchell Erickson NP, Director of Advanced Practice
ABSTRACT
Young adult patients with chronic illness who require frequent, prolonged hospitalizations may not have a medical home to coordinate an outpatient plan for transition to adult care, and some may transfer to adult inpatient care without an established outpatient medical home. In 2017, UCSF cared for over 5000 patients between the ages of 18 and 30 years with childhood-onset chronic conditions (CCCs), which accounted for over 28,000 LOS days. Almost 40% of these patients had no PCP, and many presented for care only when hospitalized. For young adults with CCCs hospitalized at UCSF Benioff Children’s Hospital, there is a need to create a coordinated adult care plan prior to transfer. For young adults with CCCs hospitalized in the adult setting, an adult outpatient care team, including a medical home, is needed to provide ongoing management. We will establish a multidisciplinary consult team, Optimizing INpatient TRansition of Young Adults with Chronic Childhood Conditions (ON TRACCC), which will include a physician and social worker. This team will leverage inpatient-outpatient partnerships to develop a transfer plan (PCP, outpatient subspecialists and inpatient hospital/ED) for frequently-admitted patients at BCH and Parnassus, starting at age 19. Ultimately, we aim to decrease costs by decreasing length of stay, 30-day readmission rates & ED utilization. ON TRACCC will also help patients to establish medical homes, and improve the provider experience of caring for these complex inpatients.
We dermatologists frequently order unnecessary lab tests for systemic medications.[1,2] We also regularly miss safety-related prescribing recommendations, increasing the risk of adverse events.[3,4] One likely cause is the lack of evidence-based standards for medication management in dermatology. Through research and collaboration with other specialties, we will develop medication management guidelines and find effective ways to implement them. This will decrease costs, improve safety, and improve patient experience.
Problem:
Infants and children who cannot breathe on their may require a tracheostomy– a surgical placement of a tube into the windpipe. Safe and standardized pediatric tracheostomy care is critical for all healthcare provides. However before a child with a new tracheostomy tube is discharged home, primary caregivers must also receive training in tracheostomy care and management of potential emergencies. Often, these caregivers are family members who do not have any medical background or training.
Infants and children who cannot breathe on their may require a tracheostomy– a surgical placement of a tube into the windpipe. Safe and standardized pediatric tracheostomy care is critical for all healthcare provides. However before a child with a new tracheostomy tube is discharged home, primary caregivers must also receive training in tracheostomy care and management of potential emergencies. Often, these caregivers are family members who do not have any medical background or training.
Whether parents of young children, children of aging parents or serving in another guardianship role, caregivers are the backbone of our society However, they are far from invincible. When they fall ill, they not only have the burden of considering their own care needs but also their care obligations forcing them to make heart wrenching decisions about whether to prioritize their health needs or those who need them. Unfortunately, hospitals have little to offer to help caregivers negotiate these dilemmas and at times even heighten the stakes (e.g.
Problem:
Problem: Young adults with serious childhood-onset conditions (CCCs) are increasingly surviving into adulthood. In 2016, UCSF Pediatric Specialties cared for over 1200 patients over age 18 who live in San Francisco. These patients often have difficulty establishing care in the adult system, with many becoming “medically homeless” and using emergency departments for care needs. Furthermore, UCSF adult PCPs report rarely communicating with pediatricians when accepting these medically complex patients.
We will: