Approved Projects for Physicians with a Relationship with Nicklaus Children's Hospital

The following projects are currently approved for ABP Part 4 MOC Credit through the Portfolio Sponsorship Program. Unless otherwise stated, these projects are only available to physicians with a relationship to Nicklaus Children's Hospital.


Project Title:
Standardization of Post-operative Management after Fontan Procedure

Project Expiration Date: June 01, 2020
Approving Board: ABP
Project Description:

Overall mortality and the incidence of early failure after the Fontan operation has significantly decreased over the last few decades, however perioperative morbidities still exist and a considerable number of patients require prolonged hospitalization after the procedure. The aim of this study was to describe our Fontan playbook (a standardized care pathway) and compare the postoperative outcomes with our institutions historical data. Specifically, this study aims at: (1) Describing our Fontan playbook (a standardized care pathway) and compare the postoperative outcomes with our institutions historical data (2) Improvement or goal is to decrease duration of chest tube placement and length of stay (3) The time limit for assessment is on a 6 month basis. Interventions include: 1) Create an algorithm pathway that can be followed by bedside nursing and the primary team to ensure patient is following an expected path of recovery. 2) Introduction of intervention: meeting with RT, nursing, physicians and ensure buy-in to pathway and answer questions prior to each fontan admission. 3) Training in proper use of pathway with flexibility. Ensure copy of pathway is available at bedside.

Completion Criteria:

Physicians must participate in the project for a minimum of 6 months. Participation may include attending QI meetings, reviewing the data collected, and/ or participating in implementation and design of the interventions.

To participate, contact the Project Leader: Kamalvir Gill, MD


Project Title:
Cardiac Arrest Prevention (CAP) Quality Initiative 

Project Expiration Date: May 01, 2021
Approving Board: ABP
Project Description:

Cardiac arrest in the cardiac intensive care unit is high and is associated with poor outcomes. Being able to detect early signs of an impending cardiac arrest can allow bedside providers to intervene prior. By implementing the elements of the CAP bundles, bedside providers are able to identify signs of impending decompensation as well as be better prepared if the patient arrests. This project aims at implementation of the 5 elements of the cardiac arrest bundle: twice daily huddles, vital signs posted at bedside, presentation discussion, weight specific epinephrine at bedside, formal review of all arrests Interventions include:

  1. “CAP SAFETY HUDDLE” – MULTIDISCIPLINARY DISCUSSION OF CA PREVENTION 2 TIMES/DAY, (AM SHIFT, PM SHIFT, CALL HAND-OFF) –GOALS AND PLANS POSTED AT BEDSIDE
  2. PATIENT-SPECIFIC VITAL SIGN GOALS ESTABLISHED AND ALARM PARAMETERS ADJUSTED & COMMUNICATED/POSTED AT BEDSIDE 
  3. PRE-SEDATION DISCUSSION FOR NOXIOUS STIMULI 
  4. EMERGENCY MEDICATIONS (EPINEPHRINE) AVAILABLE AT BEDSIDE 5.FORMAL REVIEW OF ALL CARDIAC ARREST EVENTS

Completion Criteria:

Physicians who participate in this project will need to meet the following criteria for completion: Participation in meetings of the team, implementation of intervention, review of the data, and/or designing new interventions.

To participate, contact the Project Leader: Kinjal Parikh, MD


Project Title:
Improving Efficacy and Safety of Pediatric Intensive Care Unit Patient Transfers

Project Expiration Date: May 25, 2016
Approving Board: ABP
Project Description:

Patient transfers from the Pediatric ICU were largely inefficient. Time to floor transfer ranged from hours to multiple days. Due to delays, initial handoff from ICU to floor team was inaccurate at the actual time to transfer and transfer orders were obsolete, thus increasing risk of medical errors. While awaiting floor bed, some patients were discharged home from the PICU, but floor team was never notified and patients continued to be counted in the floor team census affecting resident physician-to-patient ratios. This project aims to decrease the time lapse between the notification of PICU transfer to the floor team and actual arrival of the patient to the floor to <120 minutes within one year.

Completion Criteria:

Physicians participating in the project are eligible for MOC Credit if they meaningfully participate in the QI meetings, data review, design and implementation of interventions. Participation for a minimum of 6 months in the project is also a criterion.

To participate, contact the Project Leader: Bhavi Patel, MD


Project Title:
Brief Resolved Unexplained Events (BRUEs)

Project Expiration Date: October 12, 2020
Approving Board: ABP
Project Description:

BRUEs are a relatively new diagnosis, created from the AAP clinical guideline published in 2016. There is currently no data on whether this diagnosis is being correctly applied or on whether patients are being correctly classified as higher or lower risk. There is also no data on whether the recommendations for lower risk patients are being followed (minimal testing, no admission needed) and whether these recommendations are improving clinical outcomes. the Global Aim of this project is: To improve the care and management of infants presenting with BRUE by improving the recognition and classification of BRUE.

This is done using the following interventions proposed:

  • Creation of a note template for inpatient H&Ps with BRUE characteristics and risk classification included.
  • Conduct education with ED providers, hospitalist attendings and NPs and residents to review BRUE diagnosis, risk classification and recommendations for management.
  • Creation of a method for ED providers to give specific discharge instructions for patients with BRUE including information about CPR training.

Completion Criteria:

Physicians participating in the project are eligible for MOC Credit if they meaningfully participate in the QI meetings, data review, design and implementation of interventions. Participation for a minimum of 6 months in the project is also a criterion.

To participate, contact the Project Leader: Kathleen Murphy, DO


Project Title:
Assessment of HIV Screening in Adolescent Patients: A QI Project

Project Expiration Date: June 23, 2019
Approving Board: ABP
Project Description:

Universal HIV screening is recommended in all health-care settings after the patient is notified, unless the patient declines (opt-out screening). HIV screening was not being routinely offered in our institution’s Adolescent Medicine clinic. Residents feel uncomfortable approaching patients regarding sexual behaviors. Ignorance of HIV testing guidelines. Lack of EMR reminders. The Plan Do Study Act method of quality improvement was used. Baseline assessment consisted of a survey to evaluate residents’ knowledge regarding HIV screening guidelines, and a review of patient medical records for 2 weeks pre- intervention looking for documentation of HIV risk factors, previous HIV testing, and discussion/offering of HIV testing. Three PDSA cycles were completed. The aim of this project was to increase the rate of HIV screening offering and discussion to 90% of all patients seen in the adolescent clinic in our hospital in the 2 weeks following the interventions, with the overall goal of increasing rate in the following year.

Completion Criteria:

Physicians participating in the project are eligible for MOC Credit if they meaningfully participate in the QI meetings, data review, design and implementation of interventions. Participation for a minimum of 6 months in the project is also a criterion.

To participate, contact the Project Leader: Michell M. Lozano Chinga, MD


Project Title:
Implementation of a Toolkit for Transition Readiness Assessment in Patients with JIA: A QI project

Project Expiration Date: June 23, 2019
Approving Board: ABP
Project Description:

The American College of Rheumatology (ACR) has recommends assessment of transition readiness (TR) with previously validated tools, for all patients starting at 14 years of age, and interventions to achieve transition readiness by age 21. The Rheumatology clinic at our institution did not have a policy in place for transition readiness assessment. A smooth transition process has been associated with greater rates of patient satisfaction, empowerment and loss of follow up. The project aims to change lack of awareness of the need of a transition policy, lack of EMR reminders. Two cycles were performed. The aim was to increase the rate of TR assessment to 90% during visits to the Rheumatology clinic for patients with JIA, by launching the implementation of a TR toolkit (including GotTransition questionnaire) and advance notification to clinic staff.

Completion Criteria:

Participation in QI meetings, data review, design and implementation of interventions, and feedback.

To participate, contact the Project Leader: Diana Sofia Villacis Nunez, MD


Project Title:
Increasing Discussions on Early Peanut Introduction - A Quality Improvement Project

Project Expiration Date: October 31, 2018
Approving Board: ABP
Project Description:

Resident’s working in our continuity clinic were not aware of the LEAP addendum guidelines therefore they were not practicing these guidelines or discussing peanut introduction at well visits in our clinic. Through the use of education and visual cues, we wanted to increase resident knowledge on the LEAP guidelines. We wanted to improve discussions on peanut introduction at well visits which will include documentation. Lastly we wanted to have appropriate referral for patients that met criteria for the LEAP protocol. Our timeline included 12-18 months- 6 months of pre intervention data and 3 months for each cycle (2 cycles in total). Our goal is to improve documentation at 4 and 6 months well visit on peanut introduction.

Completion Criteria:

Physicians must be involved in the planning/ implementation/ data review/ or discussions of the various aspects of the project. The physicians involvement will be subject to attestation by the project leader.

To participate, contact the Project Leader: Priyanka Seshadri, MD


Project Title:
Improving Pediatric Resident Education at Nicklaus Children’s Hospital NICU

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

The Accreditation Council for Graduate Medical Education (ACGME) states that for the resident, the essential learning activity is interaction with patients under the guidance and supervision of faculty members who give value, context and meaning to those interactions . With increasing pressures to treat patient as efficiently as possible, teaching of medical students and residents has become a challenge for neonatologists working in the neonatal intensive care unit (NICU). The introduction of the electronic health records has added further burden to the teaching process by shifting focus from the patient to the computer screen. Factors unique to the NICU environment that make the process of teaching more demanding compared to other pediatric rotations are: 1)Opportunities to learn NICU specific material not found in other rotations. 2)Reduction in the number of work areas and NICU rotations required by ACGME. 3)High patient acuity and complexity create a highly stressful NICU environment with fewer opportunities for formal resident education. Factors that are relevant to the NICU at NCH include: 1) Lack of labor & delivery and nursery services which limit the teaching to level IV NICU setting. 2) Lack of a fellowship program. 3) Teaching responsibilities assumed by a group of private practicing neonatologists. 4) Limited knowledge for participant neonatologists about the their teaching responsibility as required by ACGME 5) Two different Electronic Heath Record System for documentation in the NICU creating an additional burden to residents and neonatologists.

Completion Criteria:

Physicians will meet completion criteria by having a 6 months participation period in the project, participation in the review of the data, implementation of the various interventions.

To participate, contact the Project Leader: Adolfo R. Llanos, MD


Project Title:
Improving Vaccination Rates in Premature Infant in a Freestanding Children’s Hospital

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

The AAP/CDC guidelines recommend that at 60 days of age, infants should receive diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, Haemophilus influenza type b (Hib) vaccine, inactivated polio vaccine (IPV), and hepatitis B virus (HBV) vaccine. The first dose of HBV vaccine is dependent on infant birth weight (BW) and maternal hepatitis B surface antigen (HBsAg) status. Only monovalent hepatitis B vaccine should be used for PT or FT younger than 6 weeks. Administration of a total of 4 doses of hepatitis B vaccine is permitted when a combination vaccine containing hepatitis B vaccine is administered after the birth dose. Because all preterm infants are considered at increased risk of complications of influenza, 2 doses of inactivated influenza vaccine, administered 1 month apart, should be offered for all preterm infants beginning at 6 months of chronologic age as soon as influenza vaccine is available. (Saari, & the Committee of Infectious Disease, 2003; Schillie et al, MMWR 2018; AAP Committee on infectious Disease Red Book, 2018). Suboptimal immunization rates in NICU graduates has been widely reported in the literature. Delayed or non-immunization during hospitalization has been also related to an increased risk for delayed immunizations after discharge. Children who are under immunized at 2 months of age are more likely to remain under immunized at 6 months, 24 months, and 36 mont1 of age. (Macintosh et al. 2017). Improving vaccination rates in NICU setting is a complex process requiring a multidisciplinary approach. A quality improvement (QI) project could be helpful in identifying and overcoming barriers related to real-time recognition of vaccine eligibility, addressing clinician’s perceptions of side effect associated to vaccine, and use of information technology and innovative solutions to improve care. This QI project aims to improve immunization rates in the NICU at Nicklaus Children’s Hospital (NCH NICU). Process and outcome measures will be assessed after various interventions targeting barriers. This pilot targets patients cared by pediatric residents and excluded admission from the emergency department.

Completion Criteria:

To be eligible for credit, physicians must have substantial participation in key activities of the projects from reviewing data, to interventions, or to measurement of outcomes.

To participate, contact the Project Leader: Alejandro Frade Garcia, MD


Project Title:
Improving Time to Antibiotic Administration in Patients with Fever and Neutropenia in the Emergency Department

Project Expiration Date: November 30, 2016
Approving Board: ABP
Project Description:

Patients with fever and neutropenia are at a high risk of developing sever life-threatening infections. Studies have shown that administration of IV antibiotics within one hour of arrival to the ED can potentially abrogate this serious event. Our initial impression was that this was not achieved at our institution due to multiple barriers. In fact our baseline data showed only 3% compliance (97% non-compliance). The aim of this project is to decrease the time to antibiotic (IV) administration in patients with fever and neutropenia presenting to the ED to < 60 minutes and lower the rate of non-compliance by 50% from baseline by tracking the rate Q 3 months for 2 years. This was achieved through multiple stakeholders and interventions including: ER flow, EMR Power Plan, Pharmacy, IV Team, Physicians, Nursing, and ER staff. Project completed with increase in compliance rates. Process was hard-wired into the ED Flow.

Completion Criteria:

Completing 2 cycles, participation in data review, interventions, and / or process implementation.

To participate, contact the Project Leader: Kamar Godder, MD


Project Title:
Work Flow Analysis and Efficiency in a Pediatric Cardiac Intensive Care Unit

Project Expiration Date: January 15, 2016
Approving Board: ABP
Project Description:

The following interventions were implemented Cycle 1: After recording the time spent rounding on each patient for a few weeks, (Baseline data), all stakeholders were gathered for a brainstorming session to decide what items needed to be covered for every patient admitted to the CICU (during and before rounds) and round flow was standardized step-by-step. Intervention 1: Agreeing on the standard process/steps - Then, team members and intensivists realized that there are inputs that were upstream to the Contributors to Quality, which could not be captured by these flow sheets, but that still needed to be addressed to help reduce to a minimum the variation in rounds. Factors were listed Intervention 2: Education & following/adoption of the standard steps: Individual Patient Encounter Work Flow Sheet (Tool Designed) & Daily Rounds Flow Sheet (Tool for Rounds and Pre-Rounds Designed)

Completion Criteria:

To qualify for Credit completion, team members should have contributed to the QI project through attending the educational sessions, team meetings, reviewing the data, implementation of the tools, and revising the tool as needed.

To participate, contact the Project Leader: Darline Santana-Acosta, MD


Project Title:
Initiative to Decrease Length of Stay in the Emergency Department for Patients with Orthopedic Injuries

Project Expiration Date: November 30, 2018
Approving Board: ABP
Project Description:

Implementation of a nursing initiative where a trained group of nurses will place appropriate X-Ray orders for patients with orthopedic injuries before the physician sees the patient. Nurses will have a didactic instruction on orthopedic injuries and will see and examine at least one patient per type of injury. Once checked off by a physician, they will be able to order X-rays.

Completion Criteria:

Participating physicians will complete the project and obtain credit if they: 1) Actively participate in implementation of the intervention(s) - education/ training 2) Collect and/or analyze and review data

To participate, contact the Project Leader: David A. Lowe, MD


Project Title:
Maximizing ED Communication for Ensuring Safe Transition for Admitted Patients to the Floor

Project Expiration Date: October 1, 2018
Approving Board: ABP
Project Description:

Admitted emergency department patients are sometimes sent to the floor by nursing without the knowledge of the treating emergency department physician. Nursing priorities include transferring patients to the floor as soon as a bed is assigned to the patient and this sometimes supersedes appropriate communication between emergency department physicians and nurses. This project aims at improving communication. Through the implementation of a check mark in the electronic medical record to be completed by the physician. This checkmark verifies that the physician is okay with the patient being sent to the floor. Monthly reminders will be given to nurses at their meetings. Physicians working in the ED will be provided with daily reminders to complete the checkmark. The SMART aim includes: Within 6 months 90% of admitted patients will be approved by the treating physician before being sent to the floor by the nurse.

Completion Criteria:

Physicians are eligible for credit if they: 1) Participate in the implementation of the intervention related to the project 2) Actively participated in data collection and/or review and analysis.

To participate, contact the Project Leader: David A. Lowe, MD


Project Title:
End of Life Palliative Care in Oncology Patients with Non-Curative Cancer

Project Expiration Date: June 30, 2018
Approving Board: ABP
Project Description:

The aim of this project would be to involve end of life palliative care upon identification of patients with terminal or advanced cancer, encourage discussions about end of life care and decrease the incidence of ICU deaths in this population in the hopes to reduce aggressive interventions that may not provide reasonable benefit to patient. This is achieved through the planned steps: Development of a screening tool: Using various screening tools that are published or obtained from other hospitals we have reviewed and developed our own screening tool. The screening tool is enclosed. Development of a palliative care consultation form: With inputs from various physicians and palliative care team members we have developed a palliative care consultation form. Involvement of palliative care team nurse: Changes included early consultation with palliative ARNP and referrals on 6T floor admissions by resident scoring system and notifying MD whether palliative consult needed. Periodic education of residents rotating through 6T and 3T (PICU): PL3 and the Chief Pediatric Resident involved in this improvement project have prepared educational materials and have provided education every block with new residents arriving for the rotation in 6T and 3T. Additional educational sessions were conducted when the compliance was lower. Educational material is included. Education of oncology attendings: We have improved awareness of the aim of the project among oncology faculty through presentations in their Division Meetings. In addition, we have presented monthly updates on the progress of the project in their meetings. Presentation of data and education to PICU attending: We have presented periodic updates on the progress of the project in the Critical Care Division faculty meetings.

Completion Criteria:

Completion criteria include physician involvement in the project for 6-12 months as a team participant in either screening, implementation, or review and providing input on the project results.

To participate, contact the Project Leader: Balagangadhar R. Totapally, MB, BS


Project Title:
Depression Screening in Adolescents with Type 1 Diabetes Mellitus

Project Expiration Date: June 1, 2018
Approving Board: ABP
Project Description:

Patients with diabetes mellitus are at increased risk for depressive symptoms and disorders, particularly female patients. About 1 in 4 patients with diabetes suffer from depression. Therefore, there is a consensus on the need for periodic screening for depression in this population. At the same time, it appears that integrating mental and physical health care may improve outcomes. It was noted that formal mental health screening was not part of the visit for diabetic patients. This project aimed at increasing (to >90%) the rates of mental health screening using a validated Quality of Life tool PHQ-9 of adolescents with Type 1 DM and consequently increase mental health referrals to >90% of those who screen positive. Interventions included Education of providers, automated text in EMR for documentation , email reminder to staff. The project was peer-reviewed and accepted for presentation as a poster at the AAP Florida Chapter Annual meeting.

Completion Criteria:

Attend QI Team meetings, participate in data collection, review or intervention.

To participate, contact the Project Leader: Alfonso Hoyos Martinez, MD


Project Title:
Increasing Meningococcal Booster Vaccination in a Primary Care Practice: A Quality Improvement Initiative

Project Expiration Date: May 28, 2018
Approving Board: ABP
Project Description:

Age appropriate MCV#2 (booster) vaccination rates (68%) in the pediatric care clinic are noted to be well below our MCV#1 vaccination rates (94%) resulting in missed doses of MCV#2 vaccinations. This is due to incomplete EMR vaccination schedule and decreased awareness of vaccination recommendations. The aim of this project is to increase the rate of MCV#2 booster vaccination for 16-17 year old patients in our pediatric care clinic with a goal to match our MCV#1 vaccination rates over the course of 1 year. The poster was presented at the Annual Scholarship Day (peer-reviewed) and at the Florida AAP Chapter annual meeting (Peer-reviewed)

Completion Criteria:

Participation in implementation of the interventions, data review or analysis. Attends QI team meetings.

To participate, contact the Project Leader: Raphael Sturm, MD


Project Title:
Pediatric Residents' Knowledge and Proficiency of Epinephrine Auto-injector Administration and Handling: A QI Project

Project Expiration Date: May 31, 2017
Approving Board: ABP
Project Description:

Patients diagnosed with anaphylaxis are often discharged from the hospital with prescriptions for epinephrine autoinjectors (EAI). The purpose of this study was to evaluate the baseline knowledge of pediatric residents regarding proper handling and administration of EAI, and to assess their knowledge after providing them with a formal one-on-one training at the time of discharge. Since education among providers and patients is needed, we believe that efforts to improve the correct use of EAI among providers responsible for training is an essential component to ensuring that patients and families receive the most accurate guidance on how to use this life saving device. The goal of this project is: To increase the percentage of residents who are confident in how to properly use and care for an Epinephrine auto-injector from baseline to 70% or higher over a 3 week period All residents participating on the study will receive one-on-one education by Allergy and Immunology Fellow of the proper administration and handling of Epinephrine autoinjector. Materials and tools Used: Attached can be found the training tool (questionnaire) used for measuring resident’s knowledge on the proper use and handling of epinephrine autoinjector.

Completion Criteria:

Completing of 2 cycles, Participation in meetings, review of the data or implementation of the plan.

To participate, contact the Project Leader: Hanadys Ale, MD


Project Title:
Decreasing Empiric Use of Vancomycin in Late Onset Sepsis

Project Expiration Date: March 30, 2017
Approving Board: ABP
Project Description:

Starting in the 3rd week of October 2016, we educated residents on unit guidelines for LOS at the onset of the NICU rotation and implemented a LOS checklist to assess provider behaviors in the evaluation and treatment of episodes of suspected LOS (see attached checklist and guidelines). The lead resident in the project met with each group of residents at the beginning of their NICU rotation to explain the importance of adherence to LOS guidelines, including the limited indications for the use of vancomycin as well as the adverse effects associated with the overuse of this antibiotic. We then explained the methodology of data collection including the indications to fill out a LOS checklist and where to find it and return it. We engaged the residents by providing reminders in their workstations to fill out the checklist for cases of suspected LOS (stickers on the computers). The residents would then be prompted to bring the checklist to rounds, thus prompting a discussion with the attending about appropriate evaluation for LOS and the choice and duration of antibiotic treatment. The checklist included an area that had to be filled out 48 hours after initiating antibiotics, thus prompting the resident to discuss with the attending if it was appropriate to continue antibiotic treatment depending on whether or not there was a microbial indication.

Completion Criteria:

Completing of 2 cycles, Participation in meetings, review of the data or implementation of the plan.

To participate, contact the Project Leader: Jessica Barreto, MD


Project Title:
Decreasing Antibiotics Use by Standardizing Diagnosis and Management of Ventilator Associated Infection in the NICU

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

We will target activities related to the primary drivers “hospital ASP and ID consultant participation” and improving “adherence to unit guidelines”.

  • Intervention 1: Develop algorithms for diagnosis and management of VAI The existing literature does not offer specific criteria for the diagnosis and management of VAI in the newborn period. Diagnosis of VAP is based on the definition provided by the Center of Disease Control for infant <1 year, which requires a combination of radiologic, clinical and laboratory criteria. Additionally, we developed an algorithm for the management of infant with suspected VAI adapted from the “Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-Associated Pneumonia” created by the American Thoracic Society Documents.
  • Intervention 2: Education and discussion of algorithm with staff. Conduct an educational campaign with the nursing staff, residents and attending physicians on the appropriate diagnosis and treatment of ventilator associated infection following the developed diagnosis criteria and management algorithm. The educational objective will highlight the difficulties.
  • Intervention 3: Implementation of Guidelines We will use the checklist that was developed in October of 2016 for the iNICQ project. The checklist was modified to evaluate if the presence of a prior ETA positive culture was included in the decision of selecting the empiric antibiotic treatment for infant with VAI.

Completion Criteria:

We anticipate conducting a minimum of 6 PDSA cycles during the 6-months period starting July 1st 2017. Completion Criteria include: - Participation in one of more of the interventions - Attendance of QI meetings to review data and provide feedback - Educating staff and fellows re. the interventions and its tools/checklists/ criteria.

To participate, contact the Project Leader: Adolfo R. Llanos, MD


Project Title:
Improving Accuracy of Location of Peripherally Inserted Central Venous Catheters Using a Tip Locating System (TLS) During Placement

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:

Studies in adults and adolescents of Peripherally Inserted Central Catheters (PICC) found a right atrial malposition rate of 18% and other malpositions at 13.4%. in pediatrics, correction of these malpositions is a time consuming process and involves discomfort to the family and patient. Additional time is needed by the bedside and PICC nurses, ordering physicians, radiology techs and radiologists. Furthermore, additional healthcare supplies are used which leads to increased waste and costs. The PICC line tip termination point is determined by external measures on the patient body (estimates) rather than real time tip location devices during PICC insertion. The aim of the project is to evaluate and compare the rate of malpositioned PICCs on the first attempt after introduction of an Ultrasound-guided Tip Locating System (TLS) compared to the baseline data gathered before its use.

To participate, contact the Project Leader: Dr. Michael Leoncio


Project Title:
Decreasing the Oversuse of CXR in Children (3y-18y) with Uncomplicated Asthma

Project Expiration Date: June 30, 2018
Approving Board: ABP
Project Description:

Preliminary data from 2016 show that there is overutilization of CXR in the Nicklaus Children’s Hospital Emergency Department (ED) and Urgent Care Centers (UCCs). The numbers of ordered CXR in cases of uncomplicated asthma are significantly higher than the national benchmark. This leads to increased exposure of children to unnecessary radiation and increased cost of care. Despite the presence of Asthma national Guidelines, there is lack of adherence to the guidelines. This could be due to multiple factors including: (1) Lack of education of providers (2) Perceived expectations of parents by the providers and (3) other historic practice patterns (4) Fear of missing diagnosis (5) Fear of litigation. This project aims at decreasing the number of CXR ordered for children with uncomplicated asthma.

To participate, contact the Project Leader: Dr. Mario Reyes


Project Title:
Decreasing the Oversuse of CXR in Young Children (1m - 1 y) with Uncomplicated Bronchiolitis

Project Expiration Date: June 30, 2018
Approving Board: ABP
Project Description:

Preliminary data from 2016 show that there is overutilization of CXR in the Nicklaus Children’s Hospital Emergency Department (ED) and Urgent Care Centers (UCCs). The numbers of ordered CXR in cases of uncomplicated bronchiolitis are significantly higher than the national benchmark. This leads to increased exposure of children to unnecessary radiation and increased cost of care. Despite the presence of new AAP Bronchiolitis Guidelines since 2015, there is lack of adherence to the guidelines. This could be due to multiple factors including: (1) Lack of education of providers (2) Perceived expectations of parents by the providers and (3) other historic practice patterns (4) Fear of missing diagnosis (5) Fear of litigation . The aim of this project is to decrease the number of CXR ordered in patients with uncomplicated bronchiolitis between 1m-1year of age. This project is only opened to hospital physicians staff.

To participate, contact the Project Leader: Dr. Mario Reyes


Project Title:
Improving Documentation of Newborn Screen in a Free Standing NICU

Project Expiration Date: December 31, 2015
Approving Board: ABP
Project Description:

Newborn Screening (NBS) is a highly successful public health program that requires timely confirmatory testing, diagnosis, and clinical management so that optimal long-term outcomes can be achieved. NICU population represents a challenge for the eddcative implementation of NBS. Contrary to infants admitted to the regular newborn nursery, who are born healthy, full-term and > 2500g; infants admitted to the NICU are sick and/or premature and/or low birth weight with a prolonged hospital stay. The interventions routinely used in these settings such as blood transfusions, NPO, and TPN solutions have the potential to affect the NBS results and may lead to delay in diagnosis and clinical management. Our analysis of NBS documentation in the NICU in January 2015 revealed a 35% rate of documentation of NBS obtained during hospitalization. The aim of thsi project is to improve the NBS documentation in the NICU to 90% over the next 12 months.
To participate, contact the Project Leader: Dr. Magaly Diaz-Barbosa


Project Title:
Improvement in the Safe and Efficient Management of Acute Scrotal/Testicular Pain

Project Expiration Date: December 31, 2017
Approving Board: ABP
Project Description:

Delays in the definitive diagnosis of testicular torsion can lead to poor outcomes and loss of function. All members of the Emergency Department team may not recognize the acute and emergent nature of this condition. Baseline data indicate that there is room for improvement in the time from presentation to the ED until final U/S read and report. The goal of this project is to improve the time required between presentation to Nicklaus Children's Hospital ED and the time of definitive diagnosis for patients presenting with acute scrotal pain to rule out testicular torsion. An institutional standard pathway is created and the project will aim at increasing adherence to the standard pathway.
To participate, contact the Project Leader: Dr. Jefry Biehler


Project Title:
Severe Sepsis Bundle Implementation at Nicklaus Children’s Hospital

Project Expiration Date: May 31, 2019
Approving Board: ABP
Project Description:
Sepsis is a dangerous systemic infection that often leads to poor patient outcomes, including mortality. Severe sepsis is a significant problem among acutely ill children. A bundle for recognition, initiation and continuation of treatment of severe sepsis based on national guidelines has been created at Nicklaus Children's Hospital but not yet implemented. The goal of the project is to Implement severe sepsis bundle at Nicklaus Children's Hospital thereby improve sepsis-related outcomes.
To participate, contact the Project Leader: Dr. Bala Totapally