Research to Enhance Children's Safety
During the past several years, the Advocate Children's Hospital has joined three other Chicago area hospitals (Lurie Children's Hospital, John H. Stroger Jr. Hospital of Cook County, and Sinai Children's Hospital) under the auspices of the Chicago Patient Safety Forum to create the Chicago Pediatric Quality and Safety Consortium (CPQSC).
The Consortium is led by Jane Holl, MD and Donna Woods, PhD (both from Northwestern). The primary goals are:
- Investigate key pediatric patient safety issues
- Design effective methods for intervention to improve the safety of pediatric health care
The goals of the Consortium are consistent with Advocate's commitment and programs designed to enhance patient safety across all of its sites and are aligned with our culture of safety initiatives.
The Advocate Children's Hospital has been involved in four Consortium projects:
Risk Informed In-Situ Simulations for Pediatric Emergency Transfers
The Risk Informed In-Situ Simulations for Pediatric Emergency Transfers project was conducted at Advocate Children’s Hospital. This 3-year project involved developing In-situ simulation scenarios, conducting In-situ simulations across the participating CPQSC sites, and evaluating their effectiveness in improving team communication. Consistent with our other CPQSC projects, the focus of the simulations and analyses was to better examine clinician to clinician communication and team functioning.
Building upon the research findings from other Chicago Pediatric Quality and Safety Consortium projects, the In-situ simulation project aimed to develop risk-informed In-situ simulation training that addressed clinician communication, teamwork, and micro-system risks during pediatric emergency patient transfers. Although many health care providers have participated in simulations with manikins that are conducted in a laboratory and are used to enhance skills involved in common procedures or emergency situations (e.g., CPR), these simulations cannot mimic the true clinical environment and do not get at the team skills and communication that are key to response efforts in the hospital environment. During In-situ simulations, clinicians participate in their “real” roles and the simulation is conducted in the actual healthcare setting versus a laboratory. In-situ simulation is particularly valuable because: (1) it offers participants an opportunity to have a “real-time” and “actual” health care setting experience that is safe and without risk of harm; and (2) it can reveal undetected or unrecognized safety risks in the actual healthcare setting. Further, after the completion of the scenario itself, the In-situ team participates in a debriefing session where the team is able to comment on performance during the simulation and discuss clinician communication and teamwork.
A total of 16 simulations were conducted across the two hospitals. About half of the simulations were of a child being transferred from a fictitious referring Emergency Department (ED) to our PICUs, and about half were from a referring ED to our EDs. Between the two hospitals, 159 individuals participated in the simulations, including nurses, respiratory therapists, chaplains, clerks, NCTs, and physicians (attending, residents, and fellows). In addition, many ancillary departments were instrumental in the implementation of the simulations, namely pharmacy, lab, and radiology.
Anticipated outcomes from participation in this project, include improved communication, teamwork, and efficiency, ultimately leading to reduced patient safety risks and achievement of even better quality of care when pediatric patients are transferred to our children’s hospitals.
Patient Safety: Strategies for Improving Pediatric Clinician Communication (Focus Groups)
The Focus Groups project included nearly 70 focus groups involving a wide range of healthcare professionals (e.g., nurses, physicians, respiratory therapists, pharmacists) and professional levels (e.g., staff nurses, nurse managers; residents, fellows and attending physicians) to learn about safety issues in communication between pediatric clinicians. Overall 300 pediatric clinicians across the Chicago Pediatric Patient Safety Consortium participated in the focus groups. Data from the focus groups was evaluated to identify key issues around clinician communication. The Focus Groups project identified several problem areas in communication between clinicians. This work resulted in the publications to date and led to additional projects.
Patient Safety: Strategies for Improving Pediatric Clinician Communication (Training Module)
The goal of the Training Module project is to develop a web-based training to standardize and enhance how clinicians communicate about their patients. Although Advocate Health Care already requires training on standardized clinician communication, this new training modules provides supplemental training for pediatric clinicians that is customized to pediatric patients, settings, and situations. The web-based training provides additional instruction on using the clinical communication tool, SBAR. SBAR communication includes the following elements: Situation, Background, Assessment, and Recommendation. Using SBAR standard communication will reduce the opportunity for errors related to poor and ineffective communication.
Risk Assessments of Pediatric Emergency Transfers (Emergency Transfers)
It is well-known that there are many opportunities for errors when children are emergently ill and need to be transferred from a setting without pediatric expertise to a children's hospital. The Emergency Transfers project looks at this situation with the goal of improving the transfer process to improve the safety of children. As a first step, this project involves the collaboration of referring hospitals and the six Consortium sites. Each Consortium site invited two outside hospitals (from whom they receive pediatric transfers) to participate in a series of sessions to conduct a failure modes effects analysis (FMEA) of the pediatric emergency transfer process. This analysis details all the steps in the transfer process and identifies areas for improvements. Once all of the FMEAs are complete across the Consortium, the goal will be to identify risks across all sites and develop potential standardized solutions among all of the hospitals.
Publications resulting from the Consortium: