Report on observership training at Children’s Hospital, Cincinnati, USA
Jan – April 2024
To: Children’s Medical Care Foundation
From: Dariusz Gruszfeld, Head of Neonatal Dept. & NICU,
Children’s Memorial Health Institute, Warsaw, Poland
Dear Sirs,
We extend our sincere gratitude to the Children’s Medical Care Foundation for sponsoring our observership training at Children’s Hospital in Cincinnati, USA. Ten of our staff members participated in month-long stays, while the heads of our Cardiothoracic Surgery and Neonatology clinics engaged in one-week programs. This report summarizes our experiences, key learnings, and how we plan to implement these insights to enhance patient care and organizational practices at the Children’s Memorial Health Institute in Warsaw.
Summary of Task Sets for each doctor and nurse pairs:
Group I
– Preoperative and Postoperative Nutrition
– Strategy for Central Venous Catheter (CVC) Placement and Care
– Strategy for Anticoagulation Prophylaxis and Treatment
Group II
– Treatment of Acute Heart Failure
– Treatment of Chronic Heart Failure
– Monitoring Children with Congenital Heart Defects Pre- and Postoperatively
Group III
– Diagnostic and Therapeutic Protocol for Children with Heart Defects: Step-by-Step
– Strategy for Respiratory Failure Management
– Strategy for Diuretic Therapy, Fluid Balance, and Renal Replacement Therapy
Group IV
– Principles of Asepsis and Antisepsis, Patient Area Management
– Principles of Treating Complex Wounds (Postoperative Wounds, Stomas, Diaper Rash)
– Principles of Collaboration with Parents and Facilitating Parent-Child Contact
Group V
– Strategy for Pain Management, Pain Monitoring, and Alternative Pain Control Methods
– Strategy for Antibiotic Prophylaxis and Treatment, Vaccinations in the NICU
– Division of Duties Among NICU Staff and Treatment Teams
Training Overview
Cardiac Intensive Care Unit (CICU) Observership – 2 Weeks
– Participants: Nurse and physician together
– Activities:
– Observed procedures in the Catheterization Laboratory (CathLab), ACCU rounds, imaging conferences, and flight plan meetings
– Customization:
– Personalized schedules without assigned mentors allowed us to focus on areas most relevant to our specialties
Neonatal Intensive Care Unit (NICU) Observership – 2 Weeks
– Participants: Nurse paired with a bedside nurse; physician with an attending professor
– Activities:
– Attended prenatal and BPD conferences, imaging sessions, simulations, and classes
– Customization:
– Training adapted to individual interests for maximum educational value
Key Observations and Learnings
Multidisciplinary Collaboration
– Team Dynamics:
– Noted seamless, respectful collaboration among multidisciplinary staff during patient reviews
– Family-Centered Care:
– Parents actively involved in treatment discussions, either in person or via phone during rounds
Advanced Clinical Practices
– Infection Control Protocols:
– Learned stringent measures to reduce CLABSI, including new disinfection methods and adhesive dressings for CVCs
– Cannulation and IV Access Care:
– Observed best practices in cannulation techniques and IV line maintenance to minimize infection risks
– Resuscitation Team Organization:
– Gained insights into efficient team organization during emergencies
Technological Integration
– Electronic Medical Records (EMR):
– Experienced advanced EMR systems like “EPIC,” enhancing data accessibility and clinical workflows
Implementation Strategies
Ongoing Projects:
– Reducing central line-associated bloodstream infections (CLABSI) rates:
– Leadership Involvement: active participation from clinic heads and the Infection Control Department
– Monitoring and Analysis as well as Strategic Planning:
– Biannual infection rate analysis; weekly peripheral blood cultures
– Developed standardized CVC care protocols; introduced new disinfection agents and dressings
– CLABSI Team Initiatives:
– Regular assessment of CVC necessity, risk evaluations, staff training, and collaboration with infection control specialists
Future Plans
- Implementing ECMO v.v. in NICU:
– Plan to introduce veno-venous ECMO soon (in a few months perspective), utilizing observed protocols and specialist contacts
- Expanding NICU Support:
– Enhance postoperative care for newborns with congenital heart defects; strengthen NICU and cardiac team collaboration
- Improving Communication with Parents:
– Guides for Parents:
– Developed comprehensive guides accessible via QR codes for immediate information
– Adopt strategies to involve parents more deeply in treatment and decision-making
- Adopting Advanced EMR Systems:
– Explore implementing an EMR system, better than actually used, similar to “EPIC” to improve documentation and care coordination
- Enhancing Organizational Culture:
– Foster a culture of respect and effective communication; implement team-building and professional development activities
- Knowledge Sharing:
– Prepare presentations of key learnings to share with colleagues and medical professionals in Ukraine
Benefits and Impact
– Clinical Excellence:
– Elevate patient care standards through advanced protocols; expect reduction in infection rates
– Operational Efficiency:
– Adopt efficient organizational structures and communication strategies; streamline better workflows with EMR enhancements
– Professional Development:
– Empower staff through exposure to leading medical practices and technologies; strengthen specialized competencies
– Patient and Family Outcomes:
– Improve patient satisfaction via family-centered care; enhance clinical outcomes with evidence-based practices
Conclusion
The observership at Children’s Hospital in Cincinnati was an exceptional experience, broadening our perspectives on patient care, collaboration, and organizational excellence. We are committed to integrating these insights at the Children’s Memorial Health Institute. The implementation of guides for parents is already enhancing our communication with families. Your support has been pivotal, and we anticipate significant benefits for our patients and the medical community.
Thank you for your support and for investing in the advancement of pediatric healthcare. We look forward to continued collaboration and sharing the positive outcomes resulting from this invaluable experience.
Sincerely,
Dariusz Gruszfeld
Children’s Memorial Health Institute
Warsaw, Poland
Click here to see observership reports of other members of the care team.