Calla Brown (MP3) talks about a joint effort to continue a project started by Ben Trappey

Posted on behalf of Calla Brown (MP3)

While Abby has been teaching ultrasound at St. Damien's, Hope, Adam, and I have been working on an evaluation project of a protocol for the admission of pediatric patients with severe acute malnutrition.  Ben Trappey, who is currently a Med Peds faculty member, our faculty advisor for the rotation, and also in the department of global pediatrics, did a four-week rotation at St. Damien's during his Med Peds residency.  While here, he worked with the staff to design an order set for malnutrition.  The order set was based on both the World Health Organization standards for the treatment of acute malnutrition and also on the Haitian Ministry  of Health protocol, and includes best practice guidelines like appropriate rehydration, feeding, and vitamin supplementation.  The staff at St. Damien's, including nurses and physicians, underwent an intensive training on its use in April of this year.  

One of the attendings asked us to evaluate the use of the order set.  We are evaluating two outcomes:  whether the order set was initiated upon admission to observation and whether the child survived to hospital discharge.  This evaluation is made easier by the department of Archives at St. Damien's.  All children who present with severe acute malnutrition, as defined by a weight-for-age Z-score of less than negative three or a weight-for-age Z-score of less than negative two with edema are entered into a book  and this data is eventually shared with the Ministry of Health.  

The Department of Archives

The Department of Archives has shared the book with us so that we can pull all of the charts from children admitted between January 1st and October 31st of this year.  From the chart we gather admission weight, gender, co-morbidities, and the above two objectives.  If the child did not survive to hospital discharge, we attempt to create a narrative history of the admission in addition to collecting objective data like vital signs, lab results, and blood sugar measurements, in order to understand as best as we can why the death occurred.  We will be collating and analyzing this data to share with the staff of St. Damien's.  Ideally together we will discover clinical correlates that could be intervened upon and then perhaps improve outcomes.  

Calla Brown (MP3) at The Department of Archives

Hope Pogemiller (MP4) at The Department of Archives

This quality improvement project has been interesting on many levels.  Firstly, we have seen many children who have been admitted for severe acute malnutrition, and in taking care of these children in partnership with the staff of St. Damien's, we have realized how critically ill a child with malnutrition can be.  Secondly, doing the project has inspired us to learn more about how treatment protocols for malnutrition were developed and what creative methods for its treatment have been implemented in different settings.  Thirdly, we have learned what a behemoth of a task it is to keep track of hundreds of thousands of paper charts in a navigable way.  We are still analyzing the data but we are excited to see what comes of this project.  Whatever the outcome, however, I think I can speak for all three of us when I say that we have learned a great deal.