Becker’s connected with two of the nation’s top pediatric hospitals to discover what tools they use to improve pediatric care that any hospital could adopt.
Caring Contacts
Omaha-based Children’s Nebraska has a low-tech, low-cost, low-time-commitment program called Caring Contacts that has reduced suicide rates among its child and adolescent patients in a mental health crisis. .
It all starts in the emergency department where every child is screened for depression and suicide ideation, regardless of why they are in the ED. In 2024, the department screened 42,000 kids and found 19% of those had a mental health concern and 100 children had an active suicide plan.
“Those kids came to the emergency department for unrelated issues — things like a broken arm or diabetes care — not for mental health concerns,” Chanda Chacón, president and CEO of Children’s Nebraska, told Becker’s. “Without screening, we wouldn’t have known how to intervene and help these kids.”
Children with positive screening are given the option to open into the Caring Contact program where a member from the emergency department social work team sends a handwritten letter to the child once a month for six months. The notes are personal to the patient and come from staff members who cared for them during their visit.
“What makes me most proud is the human connection it fosters — not just providing great care, but truly caring,” she said.
The program has run for four years and helped 1,000 children so far. There have been zero deaths by suicide among children in the program.
“This is particularly meaningful, because Nebraska has a higher suicide rate for youth ages 15 to 17 compared to the national average,” Ms. Chacón said. “In a state with a population of just 2 million, these cases are personal — our team members often know the kids and their families.”
The program is entirely run by six staff members, and occasionally other medical team members will join as well. The hospital is working on ways to advance the program in 2025.
Clinical pathways
The Children’s Hospital of Philadelphia has the largest collection of publicly available clinical pathways that outline evidence-based care for pediatric conditions. These pathways sit in the EHR alongside clinical decision support tools to make it easier for clinicians to order recommended tests and medications.
“If you visited our hospital, you’d see clinicians across our wards and outpatient clinics regularly referring to our clinical pathways through their browsers for guidance on managing their patients,” Ron Keren, chief medical officer at CHOP, told Becker’s.
Clinical teams identify areas where guidelines are needed and send a request to the clinical pathways team. There is usually a queue of 12 to 15 requests at any given time. The team prioritizes the next pathway to create by evaluating factors such as number of patients impacted, level of variation in current practices and strength of existing evidence to support best practices. Once a pathway is approved, a clinical lead is assigned and a team that represents all relevant specialties is assembled.
“This work is not easy — it takes time,” Dr. Keren said. “We’ve been refining our approach for 15 to 16 years. While it may seem daunting for a health system to implement a model like this, I encourage hospitals to start the journey.”
The pathways have improved a number of pediatric quality metrics. Among them are the following:
- The sepsis pathway has led to earlier identification and treatment, improved outcomes such as times to antibiotic administration, fluid resuscitation and survival rates.
- For conditions like bronchiolitis, the pathways have reduced ineffective intervention such as unnecessary steroids, X-rays and IV placements, and increased adherence to evidence-based practices.
- Length of stay for several conditions has declined and helped avoid delays in care.
