1. Pediatric and Adolescent Health Partners February 12, 2011

2. Disclaimer I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CMS activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation.

3. Pediatric and Adolescent Health Partners Located in Midlothian, VA We have 10 staff doctors and 1 pediatric rheumatologist with 3 locations serving 20,000 patients. Team Members: Peter Blakey, MD Tracie Williams, LPN Stephanie Fitzgibbons, LPN

4. Aim By January 1, 2012 we plan to have procedures and protocols in place to ensure: 100% return of NBS results by the 6 week well baby visit 100% of parental notification of the NBS results documented in the chart 100% of providers utilizing ACT sheets where appropriate

5. Changes Implemented Reliable Systems of Care EMR Template Changes PDSA Cycles Staff Responsibilities Protocol for Abnormal/ACT Sheets CHSCN Registry

6. Changes Implemented Finance Purchase Printed Information for Pre-Natal Meetings Planning for Additional Staffing

7. Changes Implemented Community-based Care Established Communication with State Newborn Screen Services Established Communication with Local Genetics Resources- MCV/VCU Introduction of NBS at Pre-Natal Meetings

8. Changes Implemented Active Well-informed Patients NBS Procedure/Protocol Established from Initial Well Visit thru 6 week well baby visit.

9. Cycles of Improvement Making parents aware of the NBS and its importance. ~PLAN Begin introduction of NBS at pre-natal meetings with printed materials provided to parents ~DO NBS information provided to parents at pre-natal meetings ~STUDY Parents received information well by demonstrating awareness of NBS at first well baby visit. We learned that there is a benefit to providing NBS information prior to delivery ~ACT We have continue to provide this information at all subsequent pre-natal meetings.

10. Cycles of Improvement Developed protocol to ensure timely return of results and notification of parents. ~Plan Establish a protocol to involve doctors and nurses in the acquisition of NBS results in a timely manner. ~Do Initial visit (3-5 days)-nurse inquires about NBS performed 2 week well baby visit-nurse ensures that NBS results are available, provider discusses

11. Cycles of Improvement ~Study Discovered inconsistencies in physician and nurse documentation and performance We have learned that we need better communication between nurses and doctors as it relates to NBS protocol. ~Act Planned additional meetings and inter-office email between doctors and nurses.

12. Results

20. What You Have Learned We have learned that change was a challenge, the lack of communication was a surprise. Inconsistent performance was a challenge. Staffing shortage along with a busy daily schedule provided a challenge.

21. General Lessons Learned Contributions to our success EMR Template Changes Schedule communication with state NBS lab Brochures provided at pre-natal meetings Positive feedback from parents during NBS discussions at well baby visits Anticipated issues Maintaining momentum going forward