Abstract 452

Market pressures are forcing healthcare providers to seek efficiencies and report quality outcomes. Developing efficiencies by better utilizing clinical resources is perceived as difficult for pediatric institutions - particularly children's hospitals -- as pediatric inpatient care is perceived as too complicated to manage. We developed a program tailored for our physicians and hospital to (1) assure our clinical practices are the best for our patients; (2) reduce variation in clinical practices in order to reduce clinical resource utilization; and (3) assure that improved efficiency improves or at the minimum does not detrimentally affect outcomes. We applied 2 management principles -- change process and operations management -- to design and implement this program. To drive change, we established the institutional goal to become the best pediatric health care provider. Communication of this goal and the details of this program were critical for involving physician and hospital staff. For each subspecialty, we identified middle level faculty physicians and nurse leaders to lead the process. Our team supported the process by providing all administrative support, timely resource librarian services, financial (revenue, unit utilization, cost) data, quality data, and comparative information (unit utilization and charge data based on diagnostic severity from comparable institutions). The specialty care teams with our support applied operations management analysis to clinical diagnoses which were relatively linear and not highly variable (asthma, liver and stem cell transplantation) to identify number of activities, cycle time, and variability for a care process. In diagnoses too complex for linear analysis, teams studied sets of activities (e.g. use of pharmacy, laboratory, radiology). Teams reviewed and modified their priorities based on published data and information from like institutions to assure they were current and best suited for patients. Where care changes were made -- particularly reduced use of resources -- quality indicators were developed. The management team tracked performance of the specialty care teams and reported data quarterly when care groups were found not complying to their plans or when modifications of care were made. This process developed consensus among care teams, reduced costs by eliminating variability in practice, and either improved or maintained quality in 6 of 7 specialty groups. One group did not cooperate. In neonatology, pharmacy usage was reduced 12 to 61%; laboratory from 25 to 60%; and radiology (cranial MRI was reduced by 62%). Similar reductions were achieved in pediatric critical care, stem cell transplantation, and other areas. We found that ongoing monitoring and re-education were important to sustain these practices. We conclude that a method for applying Best Practices, designed for our institution, can cause positive change.