On August 6th, 2024, a 4-way Memorandum of International Medical Partnership was signed between the Children’s Medical Care Foundation, Children’s Memorial Health Institute, the National Specialized Children’s Hospital OHMATDYT and the First Territorial Medical Union including Saint Nicholas Hospital aimed at “fostering comprehensive development of horizontal bilateral relations between each party’s healthcare facilities for the exchange of experience and best medical practices, improvement of the quality of medical services and strengthening of international medical partnership”.

Headlining this innovative partnership is the planned creation of pediatric liver and kidney transplantation programs at the National Specialized Children’s Hospital OHMADTYT and First Territorial Medical Union including Saint Nicholas Hospital in the cities of Kyiv and Lviv that comply with the requirements of the European Reference Network “ERN TransplantChild”.

Close oversight from the Children’s Memorial Health Institute, whose transplantation department is one of the largest and most highly regarded in the world, and bolstered by the European Reference Network’s vast web of partner pediatric transplant centers along with financial support from the Children’s Medical Care Foundation will enable the conducting of joint scientific research, scientific-practical medical conferences, internships for medical professionals and other educational events, helping speed the implementation of European medical standards and protocols in these two key Ukrainian pediatric healthcare facilities.

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

1. Implementing ECMO v.v. in NICU:

– Plan to introduce veno-venous ECMO soon (in a few months perspective), utilizing observed protocols and specialist contacts

2. Expanding NICU Support:

– Enhance postoperative care for newborns with congenital heart defects; strengthen NICU and cardiac team collaboration

3. 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

4. Adopting Advanced EMR Systems:

– Explore implementing an EMR system, better than actually used, similar to “EPIC” to improve documentation and care coordination

5. Enhancing Organizational Culture:

– Foster a culture of respect and effective communication; implement team-building and professional development activities

6. 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.

The Union of European Neonatal and Perinatal Societies (EUNPS), founded by Professor George Simbruner in 2006 in Vienna, Austria, is one of the premier international nongovernmental organizations advocating for the improvement of newborn care in Europe.

The Polish Neonatological Society, then headed by Professor Jerzy Szczapa, was one of the founders of this association. Every two years UENPS organizes a medical congress in a different European city selected by the UENPS Board and the Scientific Council. In the year in which the UENPS convention is not held, the ENPS European Neonatal Societies, organized by Pediatric Research, UENPS and EFCNI (European Foundation for the Care of Newborn Infants).

UENPS’s mission is to improve health care in neonatal and perinatal medicine in European countries. The main goals of UENPS are to improve the quality of perinatal and neonatal care by integrating, coordinating and adding efforts of national and scientific societies, promoting knowledge of perinatal care indicators and development of recommendations, guidelines, training for healthcare providers and any other tools to achieve the best healthcare for every newborn and the supervision of the rights of newborns, wherever they are born.

Continuing the mission of UENPS, in 2019 a department was created called “UENPS Hall of knowledge”. Its purpose is to collect all cultural experiences and activities developed over the years and offer a broader educational approach to hot topics of neonatology.

In the years 2010-2018, Prof. Katarzyna Borszewska-Kornacka was the president of the Polish Neonatal Society. During that time she organized the UENPS congress in Poland. In 2017, the UENPS Management Board choose Kraków as the venue for that year’s congress for its seat as one of the oldest universities in Europe (Jagiellonian University). The congress was held in a hybrid system that year and attracted participants from many countries in Europe and the rest of the world. Among the participants was a large group of neonatologists from Ukraine, whose participation was sponsored by CMCF.

5% of the registration fee that year was set aside for aid to Ukraine. The UENPS allocated EUR 10,000 for this assistance. Prior to the congress in Krakow, at the request of the Polish and Ukrainian representatives, From the Management Board made the decision to remove the the Russian Neonatology Society from its participation and reject the Russian woman’s lecture.

The three-day program was devoted to clinical and practical challenges in neonatology. It concerned the proceedings in the Delivery Room at the NICU and others in general neonatal issues. The congress was held in the Auditorium Maximum of the Jagiellonian University and attended by over 500 participants, including 255 neonatologists.

Many more participated in the congress virtually. The largest group of participants came from
Poland, Italy and Greece.

…And a Nice Letter of Appreciation From a Congress Attendee 

Sincerely grateful for the opportunity to visit 12th UENPS Congress 2022
Everyday Practical Challenges in Neonatology, which took place on September 2-4 in the wonderful city of Krakow, Poland.

It was a good opportunity to learn about news in the field of neonatology and hear reports from professionals from all over the world.

And I am also grateful for the opportunity to meet and communicate with respected prof. Ryszard Lauterbach, President of Polish Neonatal Society, and respected prof. Maria Katarzyna Borszewska-Kornacka.

It was extremely pleasant and important to hear from them words of support for Ukraine and Ukrainians at this difficult time.

I especially want to single out the report Marietta Charakida (United Kingdom)-Fetal Congenital heart disease This topic is very relevant for our hospital, as we have a newly created department of pediatric cardiac surgery. There are great prospects in the development of this department and prenatal diagnostics in general.

Reports about the management of multiple pregnancy were also informative, especially Antenatal management of complications of monochorionic twins by Ioannis Kyvernitakis (Germany) and Long term outcomes of monochorionic twins by Enrico Lopriore (The Netherlands).

Inspiration and significant motivation to work I received from report Juliette Kamphuis (the Netherlands) Growing up as a preterm infant who herself was born prematurely and now shares her life path, difficulties and victories in adult life.

Thanks to the CMCF Foundation for the opportunity to visit 12 th UENPS Congress 2022 Everyday Practical Challenges in Neonatology, it was unforgettable.

With best regards,
Oksana Ostalska

Department of Pediatric Surgery and Urology Wroclaw Medical University is one of the well-known and most modern in Poland. We are the tertiary reference center of pediatric surgery and pediatric urology and the only neonatal surgery center in Lower Silesia district. Since 2022 we have been a member of ERNICA (The European Reference Network for Rare Inherited Congenital (digestive and gastrointestinal) Anomalies). Patient care started prenatally in the  Obstetrics Ward continues by Neonatal Department supported with Neonatal Intensive Care Unit and Pediatric Intensive Care Unit. Our multidisciplinary team of pediatric surgeons and urologists completes with orthopedics, neurosurgeons and cooperates with other pediatric  clinics (gastroenterology, cardiology, pulmonology, nephrology), genetic counseling, physiotherapy, and psychology teams.

We specialize in minimally invasive surgery (laparoscopy, thoracoscopy, endoscopy, also in newborns), and the Head of the Clinic, prof. Dariusz  Patkowski is a recognized world-class expert in minimally invasive surgery. He has extensive experience in endoscopic surgery, especially in the thoracoscopic treatment of esophageal atresia (he has operated on over 300 children with this defect, making him one of the world leaders). He develops the internal traction, a technique of endoscopic lengthening of the esophagus used in long-gap esophageal atresia. Prof. Patkowski is also the creator of a world-wide recognized method of laparoscopic inguinal hernia surgery (PIRS – Percutaneous Internal Ring Suturing), currently utilized in at least 20 countries.

The clinic also conducts teaching and research activities. We train medical students and doctors – the department is accredited for specialization training in pediatric surgery and pediatric urology. Additionally, the Clinic Team runs a periodic “Intensive Practical Course in Endoscopic Surgery in Children” for other surgeons, and we had been the first center in Poland to host pediatric minimally invasive surgery course in 1997. We also organized numerous online broadcasts of advanced operations in real-time, with operator commentary and the possibility of asking questions (streaming both domestic and international).

Ten Ukrainian neonatologists from the cities of Lviv and Ternopil traveled to Krakow, Poland to take part in the 12th International Conference of the Union of Neonatal and Perinatal Societies (UENPS).

Organized by (and held at the auditorium of the university hospital home of) longtime CMCF partner, former CMCF Fellow and current Polish Neonatal Society President, Prof. Ryszard Lauterbach, this convening brought together many of Europe’s most highly regarded neonatologists to share insights on practical challenges of everyday neonatal care giving.

Dr. Zoryana Ivanyuk, Medical Director of Saint Nicholas Hospital in Lviv, and CMCF’s Country Managing Director for Ukraine took time away from her extremely busy schedule to attend the event along with 5 other physicians from SNH’s neonatology department.

Representing Ternopil at the event were Prof. Halyna Pavlishin, Chair of the 2nd Department of Pediatrics at Ivan Horbachevsky Ternopil National Medical University and three of her neonatology department staff.

On September 30, 2022, the Polish Lactation Consultants and Advisors held its First Summit of the Coalition for Breastfeeding at the headquarters of the Warsaw Regional Chamber of Nurses and Midwives (WOIPIP) in Warsaw, Poland.

CMCF Vice President, Jolanta Martinoff, attended the event at the invitation of Prof. Maria Wilińska, Head of the Department of Neonatology at the Independent Public Clinical Hospital-CMKP, Warsaw, and one of Poland’s strongest advocates for increasing parental and public awareness of the many benefits of breastfeeding. 

Physicians from across the globe presented findings of their research on breastfeeding’s positive impact on everything from healthy child development to family budgets, to the healthcare system as a whole, to the global economy and even to the health of the planet.

Mrs. Martinoff addressed meeting attendees about the foundation’s history and aims and invited them to get in touch regarding potential financial support of initiatives they were spearheading. 

The first physician-advocate to take Mrs. Martinoff up on her offer was Prof. Barbara Królak-Olejnik, Chief of the Department of Neonatology at Wroclaw Medical University, who invited Mrs. Martinoff to tour her department the following week.

On that visit Mrs. Martinoff had the privilege of meeting Prof. Królak-Olejnik’s treatment team and getting a firsthand look at how it handled milk banking and other breastfeeding-specific patient support strategies and techniques.

On October 15th, 2022, medical luminaries from across Poland convened at Instytut “Pominik-Centrum Zdrowia Dziecka in Warsaw to celebrate 45 years of it providing country-leading pediatric care and cutting edge medical research that has played a prominent role in the transformation of pediatric and neonatal care worldwide. 

On hand for this nationally televised event was CMCF’s Vice President, Jolanta Martinoff, who was there to receive a Meritus Pro Nati award for her and her husband’s (CMCF President, Bjoern Martinoff) tireless dedication to the two institutions’ shared aims.

Mrs. Martinoff addressed attendees about the history and close collaboration between CMCF and CZD, one that dates back almost as far as the hospital itself. In her remarks, she reminded attendees that it was one of the Institute of Mother and Child’s early pediatric surgeons, Dr. (and later Prof.) Zygmunt Kalicinski, who conceived of, and did the crucial initial outreach that laid the groundwork for, the international medico-scientific exchange that would become the Children’s Medical Care Foundation.

In the intervening four decades, CMCF has sponsored supplemental specialized medical training for no fewer than 19 current and former Institute of Mother and Child physicians at some of the world’s finest medical centers, including UCLA School of Medicine, Harvard Medical School, Columbia University Medical Center, the University of Nebraska Medical Center and Boston Children’s Hospital. 

Along with their daily delivery of exemplary pediatric care, many of these outstanding physicians have hosted successive generations of CMCF Fellows in their medical departments. We are grateful to CZD-for the standard of excellence in pediatric care it has and continues to set-and for the vital training partnership we continue to rely on to this day.

The President and Vice President of the Children’s Medical Care Foundation met recently with the Marek Migdal, MD, PhD, Director of the Children’s Memorial Health Institute, one of Europe’s largest pediatric hospitals, to discuss a new form of training collaboration which would see CMCF coordinating group supplemental specialized medical trainings at the facility’s vast medical campus in Warsaw, Poland.

The institute, also known as Instytut Pomnik Centrum Zdrowia Dziecka, or IPCZD, serves as both a scientific institute and a highly specialized children’s hospital treating children from throughout the country, as well as a large number of pediatric oncology patients currently being transferred there from Ukraine.

Among the many specialties for which IPCZD is renowned is organ transplantation. Its transplantation center is one of the largest in the world and has conducted many pioneering surgeries dating back to 1990 when it conducted the first liver transplant in Poland. Since then its physicians have also performed Poland’s first combined kidney and liver transplant, its first simultaneous transplant of the liver, small intestine, duodenum and pancreas and its first intestine transplant.

The training relationship between these two entities dates back to the foundation’s earliest days, when CMCF arranged for a fellowship at the UCLA School of Medicine for one of IPCZD’s pediatric surgeons and the co-founder of the foundation, itself, Prof. Zygmunt Kalicinski. Since that time, seventeen other IPCZD physicians have benefited from similar such observership trainings at leading American medical institutions, including Harvard Medical School, Columbia University Medical Center, the University of Nebraska Medical Center, and Boston Children’s Hospital. 

In fact, one of those pioneering fellowship recipients, the son of Zygmunt, Prof. Piotr Kalicinski, went on to establish and now head IPCZD’s transplantation center. Prof. Kalicinski has distinguished himself as one of the world’s leading pediatric transplant surgeons.

Particularly important to the training partnership is IPCZD’s state-of-the-art surgery simulation center where trainees can practice on special medical mannequins.  

Whereas the model in the foundation’s early years was to arrange for individual physicians to travel to often quite distant medical centers for stays of six weeks and longer, this new training partnership will involve entire medical teams for briefer periods of time. 

Along with being much more cost effective, this approach holds the potential to enable much more rapid improvements to health care standards and hospital treatment capacity, as every member of a visiting department’s treatment team will be able to observe how the host medical department, selected for its efficiency, manages patient flow and conducts caregiving operations.

On October 14, 2021, CMCF Vice President, Jolanta Martinoff was invited to take part in the 6th International Congress of the European Milk Bank Association.

CMCF wishes to express its sincere gratitude to Aleksandra Wesolowska, President of the Milk Bank Foundation of Poland and Associate Professor at the Laboratory of Human Milk and Lactation Research on Regional Milk Bank in Warsaw, Medical University of Warsaw, Warsaw, Poland for the invitation to participate and for her leadership in this area.

Below is an in depth interview of Assoc. Prof. Wesolowska which appeared in Miris Interviews.