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First, do no harm

A new protocol spearheaded by Sameer Gupta, M.D., has brought the rate of ventilator-associated pneumonia in University of Minnesota Children’s Hospital’s pediatric intensive care unit to zero. (Photo: Jim Bovin)

U’s children’s hospital leads the charge for patient safety

Sameer Gupta, M.D., has a passion for tending to sick kids. A critical care physician at University of Minnesota Children’s Hospital, Gupta deals with tough situations every day, fighting diseases that have brought youngsters into the hospital—the scariest of places for worried parents. But what those parents don’t see is how hard Gupta works behind the scenes to prevent already sick kids from getting sicker—from what medical professionals call “hospital-acquired conditions.”

“Anytime you introduce a piece of plastic—an endotracheal tube, a catheter, a central line—into a human body, it becomes a nexus for infection,” says Gupta, explaining one source of hospital-acquired conditions. “Bacteria love to climb on anything they can find. Obviously, we want to keep sick kids from getting things like ventilator-associated pneumonia.”

Although nationwide about 7 percent of patients admitted to intensive care units suffer from ventilator-associated pneumonia, the U’s children’s hospital has reduced that number to zero because of a new protocol developed by Gupta and his team.

Additionally, rates of central line-associated blood stream infections in ICU patients have dropped significantly, and the hospital’s neonatal intensive care unit recently marked two years without a catheter-associated blood stream infection.

Other types of hospital-acquired conditions include surgical site infections, pressure ulcers, medication errors, and falls. “We know that there are things that happen in any hospital that are preventable,” says Abraham Jacob, M.D., who was named chief medical officer of University of Minnesota Children’s Hospital last year, “so our focus has been to implement and measure best practices to reduce preventable harm to zero. We feel that our sustained focus in these areas will produce the best outcomes for our patients, reduce health care costs, and fulfill our promise to patients and their families to keep them safe.”

Communication is key to avoiding costly medical errors, says University of Minnesota Children’s Hospital chief medical officer Abraham Jacob, M.D. (right), here with fourth-year medicine-pediatrics resident Aaron Graumann, M.D. (Photo: Jim Bovin)

Best practices

Jacob leads a patient safety initiative at University of Minnesota Children’s Hospital that is part of a broader collaboration that includes Gillette Children’s Specialty Healthcare, Mayo Eugenio Litta Children’s Hospital, and Children’s Hospitals and Clinics of Minnesota.

“We’ve acknowledged that we can raise the water for all ships with a united approach to safety,” Jacob says. “It gives us the opportunity to learn from other hospitals and share our successes around patient safety concerns.”

Gupta’s success with reducing ventilator-associated pneumonias, for instance, came from a concerted effort to build a protocol based on what he calls “a bundle approach.”

“We combined a number of practices we thought would be most effective,” he says, “including oral care for patients, elevating the head of the bed, not changing the vent tubing unless absolutely necessary … Using a range of techniques together to form a standard protocol proved very effective.”

Working on preventing ventilator-associated pneumonias, however, is by no means Gupta’s only project. Together with Jacob, Gupta facilitates a daily safety call, a conference call in which as many as 28 hospital units participate. During the call, they discuss any events that occurred in the previous 24 hours that may affect patient safety.

“We use that forum to resolve issues in a quick manner, to track trends across the hospital that you might miss in just looking at your own unit, and create initiatives to deal with those trends,” Gupta explains. “Basically, we’re identifying small problems so they don’t become big events.”

To streamline that process, University of Minnesota Children’s Hospital has introduced a formal system for reporting errors or safety concerns. Staff members fill out a form documenting the concern—a patient’s bloodstream infection, a medication error, even something like discord among team members—and it gets addressed immediately in the daily call.

That approach has been so successful that the hospital is now looking to implement a patient safety team huddle every eight hours. “Even though we’re resolving many concerns quickly,” he says, “reviewing things every 24 hours often means we’re being reactive versus preventive, which is always our goal. We believe the every-eight-hour meetings will help accomplish that.”

A culture of safety

Gupta’s current research project focuses on effective ways to strengthen the workplace culture at University of Minnesota Children’s Hospital and beyond.

“It’s been shown that the culture of your inpatient unit is a strong predictor of patient safety,” Gupta says. “When you have good teamwork, you see decreased numbers of errors. So we want to develop specific techniques and procedures to help staff members build the strongest possible teams.”

Both Gupta and Jacob emphasize that the ongoing focus on patient safety is key to improving results for all patients.

“This needs to be job number one,” says Gupta. “I equate patient safety with immunizations: the more you can do to prevent harm from happening up front, the better the outcome.”

Adds Jacob: “[This hospital] can be very proud of its safety initiatives and outcomes over the past few years, and we celebrate those successes. But we won’t be satisfied until we get to zero preventable harm.”

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