Quality, Safety, Value Improvement

POSNA Safe Surgery Program

Virtual Reality Usage in Non-Invasive Surgical Sub-Specialty Procedures

In collaboration with the Childhood Anxiety Reduction through Innovation and Technology (CHARIOT) Program at Stanford Children’s Hospital, pediatric orthopaedics has introduced virtual reality and video projection in our clinics to study how it may improve our patient’s experience during outpatient orthopaedic procedures such a cast removals, pin pullings, etc.

Pre-procedural anxiety in pediatric patients has been previously shown to increase the likelihood of family stressors, agitation, sleep disturbances, and negative behavioral changes. The purpose of this study is to determine if a non-invasive distracting device (Virtual Reality headset or bed mounted Video Projection unit (i.e. BERT, Bedside EnterRtainment Theater) is more effective than the standard of care (i.e., no technology based distraction) for preventing anxiety before non-invasive surgical sub-specialty procedures among children during outpatient clinic visits.

Findings:

Richey AE, Khoury M, Segovia NA, Hastings KG, Caruso TJ, Frick S, Rodriguez S. (January 1, 2022) Use of Bedside Entertainment and Relaxation Theater (BERT) to Reduce Fear and Anxiety Associated With Outpatient Procedures in Pediatric Orthopaedics. J Pediatr Orthop. 42(1):30-34. doi: 10.1097/BPO.0000000000002005.  

Spine Surgical/Financial/Treatment Care Map/Care Pathway:

Treatment of scoliosis and related spine deformity is one of the most complex and costly surgical conditions to treat in children’s hospitals. Recent consensus-based practice guidelines developed by  POSNA (Pediatric Orthopedic Society) and SRS (Scoliosis Research Society) provide recommendations for evidence-based treatment and best outcomes for spine deformity. The management of spine deformity demonstrates remarkable variation for treatment protocols, surgical indications/techniques, and costs throughout the US, and within Children’s Hospitals. The Lucile Packard Children’s Hospital provides a high volume of operative and non-operative spine deformity cases. The development of a Spine Deformity Care Map and Cost/Value Bundle will improve clinical outcomes, reduce irrational variation, and improve value by lowering the total cost of care for this condition.

Specific Aims: The primary goal will be to reduce irrational variation in care while supporting patient/family centered variations that enhance outcomes.

1. Develop a standard care map for Spine Deformity with evidence-based treatment protocols for

   1. Outreach evaluation (in schools and communities)

   2. Optimization of anesthesia and surgical preparation

   3. Optimal procedure timing, graft choice, implant selection, Durable Medical Equipment selections

   4. Post-operative rehabilitation adapting to specific patient/families

2. Evaluate, quantity the cost of each step in the care map

3. Develop standard treatment/cost protocol that allows SCH to develop a Spine Deformity Bundle to reflect the best outcomes, lowest costs, best value for patients, families, community

4. Continually evaluate variation in the care map, to consider if some variations improve value, or align with patient/family centered care

ACL Treatment Care Map

ACL injury is one of the most common traumatic injuries in young athletes. ACL injury can lead to the development of early osteoarthritis and can have significant psycho-social impacts on young athletes due to loss of function and inability to return to sports. The development of an  ACL Care Map and financial bundle will improve clinical outcomes, reduce irrational variation in treatment, and improve value by lowering the cost of care for this condition.

Interpreting, Designing, and Implementing High Quality Research in Pediatric Orthopaedics: “Wasteful” research, defined as research that fails to make a clinical impact, constitutes up to 85% of the literature and results in ~$30B of costs annually in the US alone. On the global scale, clinically useless research costs on the order of $350B. Causes of research waste include: poor research design; poor statistical conduct; biases in interpretation; and failures in implementation. Downstream, suboptimal research output bears important implications on patient care.

As such, this multi-institutional collaboration addresses issues of reproducibility and generalizability in pediatric orthopaedic research. Current initiatives include:

1. Establishment of a quality-risk framework for evaluation of prospective research topics from the institutional standpoint

2. Case studies drawn from internal experiences with establishment/piloting this framework

3. Topical textbook chapters for the AAOS

4. Future symposia involving experts from the broader medical community

5. Future whitepapers incorporating multiple stakeholder groups.

Sports Cohort Outcomes REgistry (SCORE)

What is SCORE?

The Sports Cohort Outcomes REgistry (SCORE) is a multicenter pediatric knee arthroscopy complication quality improvement registry initiated by the Pediatric Research in Sports Medicine (PRiSM) Group (https://www.prismsports.org/).

Why is this research being conducted?

Complication registries have recently been popularized for purposes of performance and quality improvement. Although pediatric knee arthroscopy is generally a low risk surgery, the increase of arthroscopic procedures performed in the pediatric and adolescent age group has increased the need for understanding the overall, large-scale complication. SCORE focuses on gathering data from 4 main pediatric knee arthroscopic surgeries: anterior cruciate ligament (ACL) reconstruction, tibial spine fixation, meniscus repair, and discoid meniscus surgery.

Who is conducting this research and where is it being conducted?

There are ~10 institutions currently involved in this multicenter registry, lead by the Texas Scottish Rite Hospital for Children and the PRiSM Group.

Will participation in this registry affect how I am treated in the doctor’s office?

No, participation in this registry will not affect how you are treated at the clinic. Your treatment will be no different than someone not participating in the study.

Learn about our initial findings here:

Grit, Burnout and Well-being Among Orthopaedic Resident and Faculty Physicians: A Multi-Institution Longitudinal Study Across Training Levels

This is a national multi-institutional study run by Vanderbilt University with a goal of enrolling up to 1,000 orthopedic residents, fellows and faculty physicians over the course of 5 years

Grit is defined as “perseverance and passion for long-term goals” and is characterized by working towards a challenging ambition, maintaining focus and enthusiasm on this goal, and sustaining motivation for long periods of time despite setbacks. Grit has been correlated with achievement and perseverance in a wide variety of disciplines, including the military and the National Spelling Bee. In the medical field, grit has been associated with a lower risk of thoughts of attrition during residency training.

Burnout, a three-pronged syndrome of exhaustion, depersonalization and decreased feelings of professional efficacy, has become an important consideration of the medical profession. The medical training process and subsequent practice can be grueling and stressful and more than half of U.S. physicians report symptoms of burnout. Burnout is an important topic in medicine because of its potential impact on physicians’ health as well as on their medical practice and quality of care.

The purpose of this study is to determine:

1) how grit, burnout, and psychological well-being are related to each other

2) how grit may change over the course of an educational and professional career 

We hope the results from this study will help provide more information on these important considerations of the medical profession, especially because there is limited information about the relationship between these three measures. Additionally, there is limited information comparing these measures across a spectrum of levels of training or careers. We believe that this study will contribute to previous research into burnout in the medical profession and may be useful in preventing burnout and psychological distress during medical training or practice.         

Patient Reported Outcomes

 How do patients participate?

Patients will be asked to fill out a survey regarding their physical, mental and social health at every clinic visit before seeing their provider.

This will allow the provider to understand the impact of the patient’s medical treatment, track their progress over time, and make informed decisions about their healthcare.

Supply Chain Value Multi-Disciplinary Research

Watch the video below to learn more about Contracting for Supply Chain Resiliency and Value:

Enhance your Vendor Partnerships through Clinical Integration and Contracting

Journal of POSNA Article: Using Data-Driven, Principled Negotiation with a Clinician-Intergrated Approach to Achieve Best Values on Spinal Implants.

Perl JR, Seth KR, Shea KG, Wall J. Hospital Value Committees: The Role of the Surgeon in New Technology Adoption. Surgical Innovation. 28(4):401-402.

Orthopedic Approach to Building the Clinically Integrated Supply Chain. Presented by Dr. Kevin Shea. Oscar Miller Day October 28-29 2021.