Improving Team Care for Patients with Cleft Lip and Alveolus: A Quality Improvement Initiative

ObjectiveThe purpose of this quality improvement (QI) initiative was to improve access, scheduling, and completion of interdisciplinary team visits for children with cleft lip with or without cleft alveolus (CL ± A).DesignInstitute for Healthcare Improvement Model for ImprovementSettingLarge pediatric academic medical center in the United States.PatientsEighty-four (84) children with CL ± A ages 2 months to 28 months.InterventionsKey drivers included: (1) Parent and team member education, (2) scheduling procedures, (3) customized team visits. Interventions were designed around these themes and included expanded patient education materials, increased nursing engagement in dissemination of patient education, redesigned team visit scheduling systems, and improved coordination and customization of team visits.Main Outcome MeasureThe main outcome included the proportion of children with CL ± A who received their first cleft team visit prior to age 2 years, out of all children with CL ± A who underwent lip repair during the QI project period. The secondary outcome measure was the number of days between missed team visits.ResultsThe proportion of children with CL ± A who received timely team care increased from 30% to 77%. The frequency of missed team visits also increased from an average of every 20 days to every 76 days.ConclusionTargeted interventions aimed at improving education, access, scheduling, and completion of team visits can reliably promote improvements in the rates of children with CL ± A receiving interdisciplinary team care.