The Incubator
A weekly discussion about new evidence in neonatal care and the fascinating individuals who make this progress possible. Hosted by Dr. Ben Courchia and Dr. Daphna Yasova Barbeau.
The Incubator
🟠CHNC 2023 COVERAGE - Revolutionizing Quality Improvement: A Deep Dive with CHNC Experts Dr. Anthony Piazza, Dr. Eugenia Pallotto, and Dr. Beverly Brozanski
Are you ready to revolutionize your approach to Quality Improvement (QI) initiatives? Let us guide you on this transformative journey with the esteemed Dr. Anthony Piazza, Dr. Eugenia Pallotto, and Dr. Beverly Brozanski, who will walk us through the comprehensive QI projects of the Children's Hospital Neonatal Consortium (CHNC). Since its inception, this Consortium has been a beacon of progress, providing critical guidance to various institutions and teams who are committed to advancing their QI efforts. Your understanding of the QI science will deepen as we navigate through its complex facets, revealing its indispensable value to both leaders and patients.
Get ready to navigate the successful waters of Quality Improvement projects with us as we dive into the outcomes of two initiatives that led to a groundbreaking 48% reduction in post-operative hyporthermia. Garner inspiration from our expert guests as they share invaluable tips for teams embarking on their QI projects. Collaboration, stakeholder involvement, and alignment with leadership are all critical ingredients in this recipe for success.
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.
Enjoy!
So this morning our first guests are Dr Anthony Piazza, dr Jean Palotto and Dr Beverly Brozanski, and our first topic is about the multi-fold QI initiatives of the CHNC. So it seems like QI was really a pillar of you know the original thoughts behind the CHNC? Tell us about that.
Speaker 2:Who's going to take this first?
Speaker 3:Well, we started in what was it? 2011,? And with CHNC, with Black Forest, 25 Centers Lab, with Database, and we knew it would take at least two years to get people trained, put data in and then get the data out. So we really thought that we'd have to have some value, provide value to our leaders, leaders in the hospital, so, and new CLABSI, central line, san Francisco, and all three of the physicians were important. So we decided we would do a QR project and, as you know, the QI was really a few early semis. At that point, gv IHI had just done their first improvement wave, in 2006, I think. So we actually went to Cincinnati and we have a day in long training and I think the clear bus were hooked Right and that initial project, that was the slug bus. Yeah, that was, yeah, yeah.
Speaker 2:Why is it important for us to do QI? I think there's the era of randomized control trial has, I think, ended and now it's more of a hybrid where randomized control trial is still very important, but there's a big incentive to do QI initiatives. What is the importance of that?
Speaker 4:Well, I would say, with the quality improvement, we're learning from the evidence that's there and then translating that to really making the difference and improve care for the patients, Either safety outcomes policy above, so really mobilizing all of the centers that we have in CHS not to do that one together, just really empowering. We learn from each other and then we're seeing that translate to better care for the patients.
Speaker 5:Right. Well, I would also say that it pushes the quality improvement science as well, in that it becomes more acceptable as a academic career as in publications and I would just go back to what Bev was introducing us to. All our projects were challenged by each one. We kind of have this infrastructure, but then each project we've done has challenged us in what QI means and how to involve different people in collaboration.
Speaker 2:Yeah, there's something very realistic about QI, where it's measured at the bedside in a very matter of fact manner, and that presents its challenges. How has the CHNC worked on helping people learn how to do good QI?
Speaker 3:Because I think there's always bad research and good research. I'll start with that. I think what we have done is based the infrastructure on the Institute for Healthcare Improvement's model for it. That is our infrastructure and together the three of us, along with the steering committee, developed a roadmap to follow and we really adhere to that roadmap. So we start with an evidence-based practice that we distribute to scholars and then we ask them to pick from that evidence-based practice the things that they can do, and we ask the local teams to do those things and monitor them in place, and then we all follow them. So I think the beauty of it is that everybody's different. I mean, everybody has to figure out what they can do at their local center and then we provide the support, or we hope to provide the support, through faculty advice, through our steering.
Speaker 4:I was going to say. You mentioned like doing it, turning it around more quickly for the patient. So that's one thing that we're really focused on is following that data over time, helping teams see what's been happening each month so we can really do different interventions if we're not making the improvements that we need. So really mobilizing, learning from each other and following it in real time and really working to get that patient outcome for a work target.
Speaker 2:Would you say that it's about almost centralizing the experience, creating a body that has a cumulative experience with QI initiatives over time, so that if you are a novice, you can now pass and pass and pass. Pool on all this, not just the data, but the experience of this whole team, of these steering committees, in order to Stay on the right track and not VR off.
Speaker 3:It's using the infrastructure right, but that's key. Yeah, one construction that developed, ever trying to spread across it right.
Speaker 5:We also have significant educate QI education within our monthly meetings. That you know is a is a broad Number of centers and individuals with different levels of Puy so we have to address that. You'll meet Brianna here in a little bit. We take in our education to the next step with having a QI fellow and then just kind of in our other forums of quality improvement, reviewing abstracts or posters, we really we talk about ourselves all the time trying to really push whatever Group we're talking to to really look at QI as a science and not just this pre-post kind of evaluation that really look at processes in data.
Speaker 1:So that actually brings me to my next question. You all have managed to achieve like tremendous buy-in from the institutions that are part of the consortium. I see that 70% of hospitals in the CHNC are participating in QI work and and you talked a little bit about the education and the standardization Of kind of how things roll out. But can you tell us a little bit more about how you're able to support teams and engage institutions to get this kind of buy-in?
Speaker 4:I was thinking, you know, probably improvements really a team sport. So we start with a group of experts from multiple hospitals. You probably pick a project that's important to multiple hospitals and then we get those experts to really do a lot of the work. So then that can take some of that off teams and really put the metrics out there and put the background of the wife and hundreds. So just trying to do a lot of that centrally. And then the most powerful part to me is the sharing and learning.
Speaker 3:All are doing different things at different places in the project and really learning from those high performers you know just to pull in a little bit of what James talking about and I I Think that one of the most on the beauty of CHNC is that we're all in this for the patient and so we're not. It's not about us, it's not about me. It's really pulling people up and giving everybody a chance to participate and and have their name these on within their organization as a part of Called clap. So I think I think people like that, they're really, they really feel that they're part of the improvement process. So I think all the leaders within CHNC have done a really good job.
Speaker 5:They've mentioned the clinical practice recommendation, which is kind of the handbook for the evidence as we go into a, into a project, and that clearly has the evidence behind whatever we're doing. So that's a great tool for people to learn from for that project, and then a lot of our platforms will have sharing of Checklist tools or processes that can be adapted from place to place and and and, so that transparency of operation is is really key.
Speaker 2:I what's your favorite QI so far? The one either ongoing or that's completed a project that you thought, man, that's really cool.
Speaker 4:My favorite still. It was our first one. I learned a lot just in body improvement. My daughter made the little logo.
Speaker 2:She was like ten. Or tell us what it's like bug, so that people don't assume that it involves the clearing of slugs from the NICU let's see Got gun.
Speaker 3:Well, I'll say that we were so excited about that first project and we had so much enthusiasm that our second collaborative actually had two projects and I think that's one of my favorites, because Maybe you were trying to keep babies warm in the post-operative period stepped in that steps. We actually lose that outcome and we we took I don't know we did a 48 percent or so decreased and post-op the type of thing that we put that outcome Into the newborn, the newborn section of the US needs of marble horse. So we spread that across country for all this, all the centers that participated in US news. And then the second part was handoffs and that handoff was so important because so many Centers me and etology groups spread that post-operative hand after the PQ's and the heart centers, which, which was great, yeah that we were able to incite that enthusiasm around.
Speaker 5:I think mine was slugbug as well. One reason was because I was such a novice at QI so there was a huge learning curve and on top of that just kind of baseline learning curve. To introduce orchestrated testing in QI was pretty unique and have to work with some pretty amazing people Working through that process right.
Speaker 1:So do you have any words of wisdom for teams that are working on their own QI efforts?
Speaker 5:Collaboration, I think is the biggest work getting all your stakeholders. Don't work in on silo, bringing everybody from the bedside nurse to administrators, to your training.
Speaker 3:And don't underestimate the time it takes even so and really have to align with your leaders. If you're the leaders of your unit, department or division Don't believe in the project to you, then then you won't necessarily have the support to find because you may not, as a QI leader, have the authority to make it happen.
Speaker 2:Right, that's a good point.
Speaker 4:I would just as follow a standardized process when you're getting going because I think it's easy to feel Like it's easy and cutting corners on kind of the science behind QI, and every time I've done that, you know. Start with your charter and your driver diagram and defining the metrics, the important.
Speaker 2:So we're gonna take a quick break and we'll be we'll be back for more.
