During clinical rounds, physicians and staff walk from room to room to discuss cases and gather information to help establish treatment plans for each patient.
Michelle Lossius, M.D., and a team of nurses, staff members and administrators had a similar goal as they progressed down the sunlit hall of the Pediatric Cardiac Intensive Care Unit in July, only they weren’t making treatment plans for individual patients, they were looking to improve quality and safety for patients at UF Health Shands Children’s Hospital as a whole.
Since last year, the team has been visiting different units throughout UF Health Shands Children’s Hospital, said Lossius, chief of hospital medicine in the department of pediatrics and the physician director of quality for pediatrics. They talk to everyone on the unit, from nurses and physicians to parents and environmental service workers, to gauge their perspectives on issues they think could be affecting patient safety and the quality of care. Nurse managers from different units also rotate on the team to give each unit a set of fresh eyes. Even the smallest issue someone brings up can make a big difference in improving the quality of care patients receive as well as their overall experience, Lossius said.
As Lossius asks questions like “Have you noticed any issues with cleanliness?” UF Health Quality and Patient Safety senior quality improvement specialist Kati Harlan jots down notes to help the team develop action items. From there, this list of issues to address often is sent to the unit’s nurse manager to assign to team members as projects or is discussed in various hospital committees and assigned to appropriate staff members and teams from there, Lossius said. These action items can vary from things as simple as fixing communications snafus to improving staff handwashing protocols.
“It’s been pretty well-received,” said Lossius, who adopted the idea from the anesthesiology department. “There are a lot of things that have become action items because of this.”
Shelley Collins, M.D., an associate professor of pediatrics in the College of Medicine and medical director for inpatient children’s services, added, “Knowing that people are coming around and asking questions helps staff to know we are here and interested to know their concerns.”
These rounds are just one of the ways UF Health Shands Children’s Hospital is working to continually improve quality and patient safety. Many of these projects could result in improvements not only across the health system as a whole but also across children’s health throughout the state.
“We take an oath that says we will do no harm. We have an obligation to fulfill that responsibility,” Collins said. “When families bring their children to us, their expectation is we will help them and not hurt them. These initiatives have to be at the forefront of how we take care of our patients.”
For example, Collins is working with other members of the Florida Association of Children’s Hospitals to collaborate on initiatives to improve the health of children across the state. She’s working with representatives at 14 children’s hospitals on the project, which is still in the early phases of development.
“Collectively, we all are responsible for the health of children in the state of Florida and this is a unique thing we are doing,” she said. “We are trying to think of what is important globally.”
Responding to emergencies
An emergency response working group has been established for UF Health Shands Children’s Hospital, and the team has developed a pediatric sepsis protocol that will be put into place soon, Collins said.
In addition, Collins and her team received a quality grant to provide staff members multidisciplinary training for Code Blue responses.
“Before, education was not happening together,” Collins said. “We did not do mock codes together.”
The team is also in the process of reviewing the pediatric code carts used during pediatric Code Blue calls and revising them, determining what items are appropriate and necessary during a pediatric code.
In addition, staff members are developing a new communications tool that will require residents and bedside nurses to discuss each new patient face to face and put the information from their discussion into Epic. Currently, because residents and nurses enter information into Epic separately, they may not talk to each other directly initially about new patients, Collins said.
What’s key about all of these initiatives, Collins said, is that they involve staff members from all units, from nursing to respiratory therapy.
“This is by no means a physician-run activity,” Collins said. “This is a multidisciplinary group. Every initiative has to have buy-in from everyone. If we don’t have buy-in from everyone across different teams, it will fail. We are lucky that all staff believe in the same thing.”