Sustainability in pediatric hospitals: An exploration at the intersection of quality improvement and implementation science

BACKGROUND: Although new evidence-based practices are frequently implemented in clinical settings, many are not sustained, limiting the intended impact. Within implementation science, there is a gap in understanding sustainability. Pediatric healthcare settings have a robust history of quality improvement (QI), which includes a focus on continuation of change efforts. QI capability and sustainability capacity, therefore, serve as a useful concept for connecting the broader fields of QI and implementation science to provide insights on improving care. This study addresses these gaps in understanding of sustainability in pediatric settings and its relationship to QI. METHODS: This is a cross-sectional observational study conducted within pediatric academic medical centers in the United States. Clinicians surveyed worked with one of three evidence-based clinical programs: perioperative antimicrobial stewardship prescribing, early mobility in the intensive care unit, and massive blood transfusion administration. Participants completed two assessments: (1) the Clinical Sustainability Assessment Tool (CSAT) and (2) a 19-question assessment that included demographics and validation questions, specifically a subset of questions from the RESULTS: A total of 181 individuals from three different programs and 30 sites were included in the final analyses. QI capability scores were assessed as a single construct (5-point Likert scale), with an average response of 4.16 (higher scores indicate greater QI capability). The overall CSAT score (7-point Likert scale) was the highest for massive transfusion programs (5.51, SD = 0.91), followed by early mobility (5.25, SD = 0.92) and perioperative antibiotic prescribing (4.91, SD = 1.07). Mixed-effects modeling illustrated that after controlling for person and setting level variables, higher perceptions of QI capabilities were significantly related to overall clinical sustainability. CONCLUSION: Organizations and programs with higher QI capabilities had a higher sustainability capacity, even when controlling for differences at the individual and intervention levels. Organizational factors that enable evidence-based interventions should be further studied, especially as they relate to sustainability. Issues to be considered by practitioners when planning for sustainability include bedside provider perceptions, intervention achievability, frequency of delivery, and organizational influences

Aphanomyces-Resistant Alfalfa: A Solution to a Common Problem in Spring Seedings

For several decades, farmers have experienced a common stand-establishment disease syndrome when spring-seeded alfalfa was followed by extended periods of wet weather. Seedlings affected by this syndrome exhibit severe stunting as well as yellowing and reddening of seed leaves (cotyledons), but they do not wilt or collapse, as they might from a damping-off disease. Commonly, the problem affects most or all of the field. Based on research that began in the 1980\u27s, we suspected that a fungus called Aphanomyces euteiches (hereafter simply called Aphanomyces) was responsible. This root-rot fungus can be found in the majority of alfalfa fields we have sampled in central and western Kentucky. However, for many years we lacked conclusive proof that Aphanomyces was, in fact, the cause of this common problem in spring-seeded alfalfa. We also did not have rigorous proof that the syndrome could be avoided by sowing Aphanomyces-resistant alfalfa varieties, which started becoming commercially available in the early 1990\u27s. In this report, we provide a brief summary of research to support our new recommendation: that spring-seeded alfalfa should be sown only with varieties having an R or HR rating to Aphanomyces root rot (ARR)