Despite the uncertainty the pandemic has created at some health care organizations, children's hospitals can still find opportunities for quality improvement.
By Richard Brant, M.D., CPHQ
The predicted shortfall of staff, hospital beds, mechanical ventilators and personal protective equipment at the onset of the COVID-19 pandemic was enough to induce a level of anxiety rarely experienced by most health care professionals during their careers.
Nonetheless, providers throughout the world became vigilant when protecting themselves and their patients—to the extent that was obvious to even the untrained observer—advancing the culture of safety within their facilities. They are textbook examples of what the Institute of Medicine defined as the six domains of quality health care.
At WVU Medicine Children’s in Morgantown, West Virginia, the pursuit of high reliability and the development of an open safety culture was set two years before the beginning of the pandemic. The hospital developed a roadmap to plan for the growth of this work stretching over one, three and five years.
But with the onset of the pandemic and the urgency it created, the time to achieve the goals for quality and safety improvement was immediately compressed. It is now the hospital’s intent to retain “temporary” safety-motivated activities beyond the COVID-19 crisis.
There is evidence this crisis can promote growth and improvement in all quality domains. Children’s hospitals can facilitate the continued use of the conventions and tools born out of the current chaos. This will help us move along the journey to zero harm and continue with the goal of promoting the development of a true safety culture within our institutions and among care delivery partners. Here are key areas where we’ve experienced transformation despite this turbulent time.
WVU Medicine Children’s 2020 Strategic Plan targeted a significant increase in virtual care. But due to the pandemic, the hospital surpassed its goal within the first four months of the year by increasing the proportion of total visits using telemedicine by 178%. We are also expanding to allow for inpatient consultation services for care delivery partners with our subspecialists. This shift has resulted in improved access for patients, particularly for rural patient referral areas.
Quality improvement projects that historically take months to prepare and implement have seemingly developed overnight, many of which center on COVID-19 patient care processes. For example, there are projects in progress addressing the effects of isolation on routine patient care, the effect on breastfeeding success in the newborn nursery, the influence on safety event resolution work, and an evaluation of the pandemic response’s effect on adherence to best clinical practices.
Leadership rounding has long been an element of safety culture work but has in the past felt more like a purposeful act of promoting visibility and approachability. At the hospital, leadership rounding has increased throughout the pandemic and has been used as an opportunity to garner safety concerns and questions from providers. These occasions are now expected by staff members and have provided the chance for them to interact more closely and informally with the leadership team, promoting conversation and resolution of concerns in real time.
Second victims work has been a core component of quality efforts for over a year. This aspect of peer support has grown over that time, but given the acute onset and fear associated with the COVID-19 pandemic, especially among frontline health care workers, the opportunities to provide reassurance and a listening ear have been plentiful. This peer support group has begun the creation of a regular “Almost Daily Distraction” newsletter to provide a short but welcomed interruption to taxing work. In addition, the intensive care unit created an employee relaxation area for lessening anxieties through physical or mental exercises.
The daily safety briefing is a tool that had been discussed at the organization frequently for the last two years but was never implemented. With the onset of the pandemic, the need for a multidisciplinary conference call at the start of the day was evident and critical to address operational and safety concerns. To fill this gap, the Children’s Hospital Daily Safety Briefing was created.
This was initially focused on issues related to the pandemic, including isolation precautions, visitation and workflows. It has evolved as inpatient volume increases and elective surgeries restart to include operational data, significant safety events from the prior 24 hours, and an opportunity for anyone to bring any safety concern to the attention of the hospital leadership to facilitate immediate attention.
Spreading the work
This year was to be the one we planned to spread the safety work across the care delivery system, collaborating with other affiliated regional community hospitals that provide pediatric care. But the onboarding strategy for 2020 accelerated when it became clear early in the pandemic the value that real-time collaboration among these facilities could represent.
An invitation was extended for a video conference with physician, nursing and administrative leaders of this group of affiliated hospitals to collaborate on current pandemic-related processes and learn from each other. The initial meeting was so productive and well received, we now hold them weekly with the intention of continuing beyond this crisis as our focus shifts to other opportunities for enhancing the quality of care for the organizations’ shared pediatric population.
Richard W. Brant, M.D., CPHQ, is medical director for Quality and Patient Safety, Pediatric Hospital Medicine at WVU Medicine Children’s in Morgantown, West Virginia.
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