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Abstract Background Hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) were historically thought to be distinct entities, often managed in isolation. In fact, these conditions are closely related. A collaborative approach, which incorporates expertise from subspecialties that previously treated HLH/MAS independently, is needed. We leveraged quality improvement (QI) techniques in the form of an Evidence-Based Guideline (EBG) to build consensus across disciplines on the diagnosis and treatment of HLH/MAS. Methods A multidisciplinary work group was convened that met monthly to develop the HLH/MAS EBG. Literature review and expert opinion were used to develop a management strategy for HLH/MAS. The EBG was implemented, and quality metrics were selected to monitor outcomes. Results An HLH/MAS clinical team was formed with representatives from subspecialties involved in the care of patients with HLH/MAS. Broad entry criteria for the HLH/MAS EBG were established and included fever and ferritin ≥500 ng/mL. The rheumatology team was identified as the “gate-keeper,” charged with overseeing the diagnostic evaluation recommended in the EBG. First-line medications were recommended based on the acuity of illness and risk of concurrent infection. Quality metrics to be tracked prospectively based on time to initiation of treatment and clinical response were selected. Conclusion HLH/MAS are increasingly considered to be a spectrum of related conditions, and joint management across subspecialties could improve patient outcomes. Our experience in creating a multidisciplinary approach to HLH/MAS management can serve as a model for care at other institutions.

Abstract The Medical Student Workshop is a companion piece to the Core Resident Workshop, as well as the other elements in the I-PASS Handoff Curriculum. Its curricular materials have been modified to meet the needs of a group of more novice learners during their introduction to clinical care. The workshop includes a 60-minute didactic and interactive session that is devoted to team training in structured communication techniques and to the teaching of a standardized approach to the handoff process, including the integration of verbal and written handoff components. Key structured team communication techniques and the I-PASS mnemonic are taught in detail and reinforced with the use of trigger videos and large group discussion. The final 30-minutes of the workshop are devoted to two handoff simulations exercises. The handoff simulation exercises feature interactive role plays in which participants (in groups of two or three) gain hands-on experience and practice the I-PASS handoff technique under the supervision of a faculty member or senior resident. Similar in content to the I-PASS Handoff Core Resident Workshop, this workshop has been tailored to fit the needs of medical students as novice clinicians with limited clinical experience and emerging medical knowledge. This curriculum was implemented for third- and fourth-year medical students during their inpatient pediatric rotations from June — December 2013 at six medical schools and pediatric hospitals across North America including: (1) University of Cincinnati College of Medicine/Cincinnati Children's Hospital Medical Center; (2) UCSF School of Medicine/Benioff Children's Hospital; (3) University of Utah School of Medicine/Primary Children's Medical Center; (4) Drexel University College of Medicine/St. Christopher's Hospital for Children; (5) University of Toronto Faculty of Medicine/Hospital for Sick Children; and (6) Stanford University School of Medicine/Lucile Packard Children's Hospital.