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Transforming into a Learning Health System: A Quality Improvement Initiative.

Jennifer L Chiem1,2, Elizabeth E Hansen1,2, Nicolas Fernandez3,4

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The Bellevue Clinic and Surgical Center demonstrates a learning healthcare system by improving surgical efficiency, patient care, and reducing environmental impact. Continuous quality improvement efforts enhance pediatric surgical outcomes and community health.

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Area of Science:

  • Healthcare Management
  • Quality Improvement
  • Pediatric Surgery

Background:

  • The Institute of Medicine's Learning Healthcare System (LHS) concept, introduced in 2006, focuses on quality, safety, and value to improve patient outcomes.
  • The Bellevue Clinic and Surgical Center, an ambulatory surgical center, is committed to continuous quality improvement for pediatric surgical patients.

Purpose of the Study:

  • To evaluate the implementation and impact of a Learning Healthcare System at an ambulatory surgical center.
  • To assess improvements in efficiency, effectiveness, efficacy, equity, and environmental safety within pediatric surgical care.

Main Methods:

  • Utilized statistical process control charts to analyze electronic health record data over seven years.
  • Focused quality improvement initiatives on surgical block time use, opioid-sparing protocols, enhanced recovery programs, racial disparities in readmissions, and greenhouse gas emissions from anesthetics.

Main Results:

  • Achieved a 37% increase in monthly surgical volume through improved urology surgery efficiency.
  • Successfully adapted opioid-sparing protocols and implemented a pediatric enhanced recovery program.
  • Reduced facility's greenhouse gas emissions from inhaled anesthetics by over 85% and continued efforts toward healthcare equity.

Conclusions:

  • The Bellevue Clinic and Surgical Center exemplifies a learning health system through sustained, patient-centered quality improvement.
  • Ongoing initiatives in efficiency, effectiveness, efficacy, equity, and environmental safety positively impact the served community.