Shawn Ralston, MD and Thomas Mayes, MD, MBA
University of Texas Health Science Center at San
Antonio

Hospital Medicine is a very young field.

Most academic divisions of hospital medicine do
not have depth in research or leadership.

Adult hospitalists have embraced quality
improvement as a key career activity.

The Division of Inpatient Pediatrics at UTHSCSA
was formed in 2007.
1)
To increase the number of active quality improvement
projects in a children’s hospital by intensive quality
improvement training of pediatric hospitalists.
2)
To increase the academic productivity of the division as
measured by the number of abstracts, presentations and
publications.
1)
To increase the number of hospital leadership roles filled
by pediatric hospitalists.
100
90
Utilization Rates for Non-Evidence Based Therapies
80
70
2008
Preintervention
(321 pts)
60
50
2009 Intervention
(155 pts)
40
30
2010 Follow-Up
(409 pts)
20
10
0
ALBUTEROL
STEROIDS
CPT
80
Nursing Care Satisfaction Scores
70
60
Friendliness/courtesy
50
Promptness
40
Attitude
Personal Need
30
Clear Language
20
Skill
10
0
2007
2008
2009
-0
8
8
Month
-1
0
1
A
pr
-1
1
Ju
n11
b1
ec
0
ct
-1
Fe
D
O
0
-1
0
A
ug
n1
Number of False Positives
12
Ju
9
A
pr
-0
9
Ju
n09
A
ug
-0
9
O
ct
-0
9
D
ec
-0
9
Fe
b10
A
pr
-1
0
b0
ec
ct
-0
Fe
D
O
-0
8
A
ug
Run Chart Contaminated Cultures
18
16
14
Intervention
10
False Positives
Linear (False Positives)
8
6
4
2
0
394.0
Preintervention Data
UCL
343.5
Pre/Post Intervention
294.0
251.7
Total time in mins
Postintervention Data
194.0
94.0
CL
93.1
108.0
-6.1
-65.6
-106.1
-206.1
LCL
-127.5
Total discharge time in min
Statistical Process Control Chart showing project events by month
18
Pre Intervention period
Intervention
16
15.72
14
Reports
12
UCL
12.16
10
8
7.50
6
CL
5.27
4
2
0
June 09
Jul y 09
Aug 09
Sept 09
Oct 09
Nov 09
Dec 09
Jan 10
Feb 10
Time Period
Mar 10
Apr 10
May 10
June 10
Jul y 10
Aug 10
Medication Errors per month on 3rd and 9th at CSRCH
0.002
POSTINTERVENTION
PREINTERVENTION
0.002
0.002
0.002
No. of Errors/Total Doses
0.001
0.001
0.001
0.001
0.001
UCL
0.001
0.001
0.000
CL
0.000
0.000
0.000
LCL
Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10
0.000
Jan-11 Feb-11 Mar-11 Apr-11 May-11
Anticipatory Guidance Given per Number of Patient Handoffs
1.200
Post-Intervention Data
1.000
Rate of Anticipatory Guidance Given
1.000
Intervention
Pre-Intervention Data
0.789
0.800
0.600
0.582
UCL
0.463
0.400
0.200
CL
0.163
LCL
0.000
11-Jun
14-Jun
16-Jun
20-Jun
21-Jun
25-Jun
27-Jun
29-Jun
Date
13-Jul
15-Jul
20-Jul
25-Jul
27-Jul
3-Aug

Ralston S, Hill V, Martinez M. Hypertonic Saline Without Adjunctive Bronchodilators in
Children Hospitalized for Bronchiolitis. Poster presentation at Pediatric Academic Societies
Annual Meeting. May 2010.

Adame N, Wilson R, Arandes M, Ralston S. Family-Centered Rounds Improves Patient and
Nurse Satisfaction. Oral Platform Presentation at Southern Society for Pediatric Research.
February 2011. Poster presentation at Pediatric Academic Societies Annual Meeting. April
2011.

Hill, VL. Arandes-Matthews M. Reducing the Children’s ED Blood Culture Contamination
Rate by 50%. Poster presentation at Society of Hospital Medicine Annual Meeting. May
2011.

Seitze C, Wilson R, Hill V. Speaking the Same Language: Improving Interprofessional
Teamwork. Poster presentation at Children’s Hospital Association of Texas. October 2011.

Ralston S, Hill V, Martinez M. Hypertonic Saline without Adjunctive Bronchodilators in
Children Hospitalized for Bronchiolitis. Pediatrics. 2010;126:e520-5.

Christus Health System Touchstone Award for Clinical Quality –
Bronchiolitis – 2010

Christus Health System Touchstone Award for Patient Centered Care –
Family Centered Rounds – 2010

Dr. Kelsey Sherburne from Instructor to Assistant Professor – 9/1/2011

Dr. Stephanie Reeves from Instructor to Assistant Professor – 9/1/2011

Dr. Michelle Arandes from Assistant Professor to Associate Professor –
9/1/2011

Dr. Noemi Adame from Assistant Professor to Associate Professor –
9/1/2011

Dr. Noemi Adame, Medical Director, University Hospital
Pediatric Transition Unit

Dr. Vanessa Hill, Medical Director for Inpatient Services,
Christus Santa Rosa Children’s

Dr. Michelle Arandes, Chief of Staff Elect, Christus Santa
Rosa Children’s
Quality improvement training and activity had a
major impact on the productivity of an academic
pediatric hospitalist division and can provide a
strong basis for academic career development.