Initiative Owner(s): Christopher Holland, Laura Coco, Ari Hoffman, Stephanie Rogers
Executive Sponsor: Adrienne Greene
Project Manager: Ari Hoffman
ABSTRACT
A Clear Path Home: Discharge Workflow Improvement for Pediatric Transitional Care Patients
Initiative Owner(s): Dinarte Viveiros (BCH Acute Care Director), Deb Franzon (TCU Medical Director), Nancy Lee (TCU Assistant Nurse Manager), and Kristine Cannon (Supervising Lean Consultant)
Executive Sponsor: Kim Scurr (Executive Director/VP of Operations, BCHSF)
Project Manager: TBD
ABSTRACT
Initiative Owners:
Name | Title |
Nerissa Ko, MD | Medical Director |
Kelly Bushman, RN, BSN, CNRN | Unit Director |
Theresa Mueller, RN, MS, CCRN |
Exercise testing allows organ function to be assessed in the stressed-state. At UCSF, we commonly perform two major types of exercise testing: cardiopulmonary exercise tests by cycle ergometry (CPET) and cardiac tests by treadmill (TST). The former provides a comprehensive assessment of cardiopulmonary fitness. The latter is primarily used to probe for inducible myocardial ischemia. Both provide extensive clinical information. Any physician can refer a patient for CPET or TST. Often, patients undergo multiple types of exercise tests, or start an exercise test, only to have it converted to a pharmacologic stress test due to mobility limitations. Given that these are costly, time-intensive tests, with a long wait-time for testing and a small but non-zero risk of causing harm, the benefits of reducing unnecessary exercise testing would be significant and immediate. We propose a multi-pronged intervention to reduce unnecessary exercise testing at UCSF by improving coordination between the Cardiology and Pulmonary exercise labs, formalizing the process of reviewing studies for appropriateness, and implementing an educational curriculum with clinical decision support based on published guidelines from the American Thoracic Society/American College of Chest Physicians1 and American College of Cardiology/American Heart Association2. Based on results of a quality improvement project which categorized 17% of TST referrals as inappropriate, we anticipate eliminating at least $500,000 of unnecessary testing annually, based on conservative assumptions (10% reduction in TST and 5% reduction in CPET). In addition to reducing costs, our interventions will improve access, accelerate treatment decisions, and improve care delivery.
Initiative Owner(s): Rochelle Szuba
Executive Sponsor: Jeff Kalin
Project Manager: Matt Bogerman
Project title
Development of a clinical pathway for head and neck cancer patients
Initiative owner
Chase M. Heaton, MD
Executive sponsor
Laurel Bray-Hanin
Project manager
Nihari Patel
Abstract
Opportunity
The Health Outcome (including Background): Acute kidney injury (AKI) is a common condition in hospitalized patients, which is associated with adverse short and long term outcomes, including mortality, chronic kidney disease and end-stage renal disease. Recently, in an analysis of the National Inpatient Sample, AKI was associated with increases in hospital costs ($7933, 95% confidence interval [CI], $7608-$8258) and length of stay (3.2 days, 95% CI, 3.2-3.3 days) (1). At present, we have no interventions to treat AKI.
Background: Social determinants of health are an increasingly recognized contributor to morbidity1; however, the medical community has only recently started standardizing the vocabulary of social determinants in healthcare. The Institutes of Medicine has recently published guidelines defining domains and measures for social determinants2. Similarly, the PRAPARE project by the National Association of Community Health Centers has created a toolkit with a standardized survey assessing social determinants3.
Background: Recent work on addressing high cost drugs conducted by the Medication Outcomes Center at UCSF found that oncology medication cost is typically not addressed as part of therapy decision process until issues arises with payer denial. As a result, patients may face an unexpected financial burden associated with treatment plans, leading to depression, anxiety, and decision to discontinue or not adhere to treatment (de Souza 2016).