The following are samples of past and current Fellowship Reports
Warsaw, 9/29/2024
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 MemorialHealth 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
Edyta Ryciak
Children’s Memorial Health Institute In Warsaw
25 March 2024
Report
I would like to thank for the opportunity to attend 4 weeks (29.01-25.02.2024) a clinical
observership at Cincinnati Children’s Hospital Heart Institute. The assumption of our stay was to
get to know the organization of the department's work, observe daily activities and work in the
on-call mode. Our goal is to introduce or update the existing standards of care for children, with
particular emphasis on children with congenital heart defects hospitalized in our Clinic
We had the unique opportunity to watch the work of cardiologist and cardiac surgeons taking
care of small children. We impressed with their professionalism towards the problem of
treating complex heart defects. From my point of view as a cardiologist, it was very valuable to
follow the diagnostic process and then watch the difficult process of qualifying children for
cardiac treatment.
Our task was to gain knowledge about patient care in the pre- and post-operative periods. We
were introduced to the department by Ivan Wilmot, MD Director, Pediatric Cardiology
Fellowship Program. We have obtained scientific materials thanks which we can compare the
European standards of treatment of heart failure in children with the American ones.
Worth mentioning is the fact of friendly cooperation of such large team focused around a single
goal.
It was a new experience to be in a veritable “Tower of Babel” where both doctors and patients
came from different part of the world.
We will share our acquired experience with our colleagues at work We hope that raising the
standards of our care for the little patients.
The next two weeks we spend in the Newborn Intensive Care Unit. We got acquainted with the
procedures in force at the Clinic. We had a chance to observe a difference in the treatment of
newborns and premature babies compared to our country.
We are sure that we will be able to use some of the procedures in our Clinic.
I would like to sincerely thank Foundation for your support and time during my observership
Kind regards
Edyta Ryciak
Agnieszka Szadkowska
Children’s Memorial Health Institute In Warsaw
25 March 2024
Report
From January 29 to February 25, I had the opportunity to attend a clinical observership at
Cincinnati Children’s Hospital Heart Institute.
The assumption of our stay was to get to know the organization of the department's work,
observe daily activities and work in the on-call mode. Our goal is to introduce or update the
existing standards of care for children, with particular emphasis on children with congenital heart
defects hospitalized in our Clinic My group focused primarily on the treatment of acute heart
failure and the monitoring of children with congenital heart defects in the pre- and post-operative
periods.
The first two weeks We had the opportunity to observe the work at the Heart Institute. We were
introduced to the department by Ivan Wilmot, MD Director, Pediatric Cardiology Fellowship
Program. We had the opportunity to familiarize ourselves with the procedures in force at the
Clinic. We were able to compare them with those that are currently in force in our country.
We were very impressed by the daily morning meetings, where we were able to follow the
treatment of patients from the first day of stay to discharge. We spent the next two weeks in the
Newborn Intensive Care Unit. We got acquainted with the procedures in force at the Clinic. We
had a chance to observe a difference in the treatment of newborns and premature babies
compared to our country.
From my point of view, as a ward midwife, I had the opportunity to observe the work of the
nurses. I am impressed by their knowledge and the education the hospital offers them.The
training series I saw was amazing. I would really like to transfer this to our conditions in Poland.
We will share our acquired experience with our colleagues at work. We hope that raising the
standards of our care for the small patients.
I am convinced that the experience gained during the internship will be useful to me in my future
career. I would like to sincerely thank Foundation for your support and time during my
observership.
Kind regards,
Agnieszka Szadkowska
Warsaw, April 4th 2024
Anna Sowa
Children’s Memorial Health Institute
Aleja Dzieci Polskich 20
Warsaw, Poland
Report of the Observership in USA
The aim of this report is to present the Observership at Cincinnati Children’s Hospital Heart Institute from February 26- March 22. Thanks to the fellowship sponsored by CMCF I had the opportunity to spend 2 weeks in Cardiac Intensive Care Unit and 2 weeks in Neonatal Intensive Care Unit.
From February 26 to March 8 th I had the opportunity to observe the daily work in CICU. The early mornings from 6.30 until 09.00 were dedicated to lectures, case presentations and imagining conferences. From 9.00 until 12.oo I participated in Clinical Rounds with specialists from different fields. In the afternoon we had the opportunity to see the clinical bedside work, procedures and also cooperation and communication between different departments. The organization of work and teaching in the Heart Institute is unique and inspiring.
I had the opportunity to see long-term outcomes of Patients in the Pulmonary Hypertension Clinic. I spent two days in Cardiac Cath Lab which was a unique experience and learning opportunity. From March 11- March 22 I had the opportunity to observe the daily work in NICU. Early mornings from 7:30 till 12.00 were devoted to Clinical Rounds, as observers we had the possibility to follow different teams working with different patients, particularly surgical team and bronchopulmonary dysplasia team, due to my interest in those fields. In the afternoons we observed bedside procedures but also had the opportunity to observe reanimation codes, the latter being very contributive to every neonatologist experience. Moreover, during our stay in NICU I had the possibility to participate in reanimation simulations in Simulation Center and also In Situ Simulations (NICU, ER) organized by the dedicated simulation team.
During whole stay we could discuss clinical questions with attendings, fellows and nurses, who passionately and willingly shared their knowledge and experience.
In conclusion it was a very intensive and productive month. Focusing on the most important aspects me and my colleagues will try to implement the gathered knowledge and experience in our Unit. Communication methods, attitude and kindness we experienced in CICU and NICU at Cincinnati Children’s are also a unique add value to my stay in the USA. Ms President, I would like to express my gratitude to CMCF for making this observership possible.
Respectfully,
Anna Sowa
Children’s Memorial Health Institute
Warsaw, Poland
Agata Szczepkowska
Departament of Neonatology
Klinika Neonatologii, Patologii i Intensywnej
Terapii Noworodka i Niemowlęcia
Warsaw, 4th April 2024
Report of the Observership in Cincinnati Children’s Hospital
February 12th – March 10th 2024
Cincinnati Children’s Hospital Heart Institute – Cardiac Intensive Care Unit (February 12th – February 23rd 2024)
Neonatal Intensive Care Unit (February 25th – March 8th 2024)
Aim of report: Present the schedule, experience and knowledge gained during observership in USA
Thanks to the fellowship sponsored by Children’s Medical Care Foundation I had the opportunity
to spend 4 weeks on clinical observership at Cincinnati Children’s Hospital Medical Center.
The first two weeks of observership (from February 12th to February 23rd 2024) were destined to
Cardiac Intensive Care Unit (CICU) followed by remaining two weeks (from February 25th do March 8th 2024)to Neonatal Intensive Care Unit (NICU).
During my internship in CICU I participated in many great lectures, case management and imagining
conferences. Every morning I joined the Clinical Rounds during which the patient’s care plan was
established. In the afternoon I had the opportunity to see the clinical bedside work and different
procedures. Throughout my stay in CICU I could learn about evidence-based management strategies of
cardiac patients, with particular emphasis on fluid balance, treatment of cardiac failure and chylothorax.
The chance to observe work in the Pulmonary Hypertension Clinic was a great learning experience about
the long-term outcomes of patients with different cardiac problems.
The following two weeks I observed the work in Neonatal Intensive Care Unit. I participated
in Clinical Rounds which were devoted to patients with various problems, most related to extreme
prematurity and its complications, congenital defects of the respiratory, urinary and gastrointenstinal
defects. I have gained some insight on management of newborns with necrotizing enterocolitis from both
neonatal and surgical perspective, with a special attention to intestinal rehabilitation. I was able to learn
in detail the principles of prevention of catheter-related bloodstream infections, especially about central
line building, dress changing and using the aseptic technique during clinical procedures.
Moreover, I participated in several different resuscitation simulations both in Simulation Center
and in-site. During my whole stay I could discuss clinical questions with medical personnel,
who passionately and willingly shared their knowledge.
The opportunity to observe the perfect functioning of the best children’s hospital in the USA was
a great privilege and an inspiring experience both professionally and personally. The things I appreciated
the most during my stay in Cincinnati Children’s were communication and organizational strategies,
positive attitude, and kindness we have experienced. I hope that we will be able to implement some of
the procedures we have learned during our observership, to improve the quality of care we provide to
our patients in the long term.
Once again, I would like to express my gratitude to the Children’s Medical Care Foundation
for helping me gain valuable professional experience.
Kind regards,
Agata Szczepkowska
Report on Medical Observership in the United States of America in
Cincinnati Children’s Hospital Medical Center
During my medical observership (26th February – 22nd March) in the United States at
the esteemed Cincinnati Children’s Hospital Medical Center, I had the privilege to immerse
myself in the intricacies of the Cardiac Intensive Care Unit (CICU) and Neonatal Intensive
Care Unit (NICU).
The primary goal of this observership was to enrich my understanding and expertise
in the realms of neonatology and cardiology.
Throughout this insightful experience, I actively engaged in a spectrum of patient care
activities. My role allowed me to closely observe every facet of operations within the NICU
and CICU.I witnessed firsthand the comprehensive care provided to newborns, from
admission to discharge, and gained exposure to procedures ranging from central cannula
insertion to intubation and resuscitation. Moreover, I actively participated in procedures
conducted in the catheterization room and pulmonary hypertension treatment clinic, and
benefitted from staff training sessions on resuscitation techniques, intravenous line
placement, and ventilation protocols.
This observership provided me with invaluable experience in managing diverse
medical conditions and honed my communication skills through regular interaction with
healthcare professionals. Participating in intricate clinical cases further enriched my
medical knowledge and reinforced my dedication to the field.
I extend heartfelt gratitude to the entire team at Cincinnati Children’s Hospital
Medical Center for their warm hospitality and unwavering support throughout my tenure. In
conclusion, this observership significantly enhanced my professional acumen and personal
growth. I am indebted to CMCF for this enriching opportunity and confident that the
knowledge gained will profoundly benefit my future endeavors in medicine.
Kind regards,
Zuzanna Kaszuba
Instytut „Pomnik – Centrum Zdrowia Dziecka”
Report of observationship in Cincinnati Childrens Hospital
Together with my colleague, Aleksandra Pietrzyk, a neonatologist, we spent a month in Cincinnatis Children’s Hospital. We spent 2 weeks in the CICU and 2 weeks at the NICU. We also had a chance to visit the Cath Lab, Pulmonary Hypertension Clinic, and even the fetal care department and OR.
Our main goal was to observe and find ways and procedures that we could implement our Unit , that could boost our efficiency, and help us improve the quality of our care for the benefit of our patients.
The aim of this report is to present a summary of our stay in Cincinnati and share my thoughts.
March 11th -23rd 2024
On our first day we were greeted by Jenifer Blair from global health.
She gave us a tour of the grounds, and took us to the Heart Institute on the 4th floor in Location D. We met with Teresa Racke, who gave us our plans for the time of our stay and she introduced us to one of the directors of the Heart institute, Ivan Wilmont.
Then we were taken to the CICU on the 6th floor in location B and introduced to Dr David Cooper. We joined rounds on the CICU and observed the process of assessing, analysing, treating and management of the patients in the CICU.
For the next two weeks we took part in rounds with the attending doctors : David S. Cooper, Alexis Benscoter, Katja Gist, and Meghan Chlebowski, and their fellows. We observed the process of managing patient care, through surgical rounds and floor rounds. We were interested in the way patient care is handled by the doctors, nurses and all the other staff members. Differently than in Poland , the medical staff all rounds together daily, and during these rounds asses the patients problems and decide on the treatment plan. Every person takes care of their field of expertise, (the dietician suggests feeding, the pharmacist assists with medicine and drug interactions and the right dosing, the respiratory therapist is responsible for weaning protocols, the nurses suggest nursing interventions, and the fellows and attendings gather all this information together and make orders).
For the most part the patients of the CICU were infants with congenital heart diseases including: HLHS, TGA, VSD, ASD, CoA, PH, TVR, MVR, and many other conditions that led to heart failure. There were also patients on VAD’s including : BERLIN hearts, Impala devices, Heart Mates, and some on ECMO treatment awaiting transplantation either of the heart or the heart and lungs. There were also adult patients recovering from heart of lung transplants.
On our first and second day we got to witness two extubations : one in a 29 yo male patient with agile syndron, ToF, ex liver transplant, after the replacement of the RV-PA stunt due to bacterial vegetation.
The second patient was a 6 yo boy, with pulmonary hypertension.
This was a very interesting procedure for us because we don’t usually work with larger children, and especially not with adults.
We also took part in CICU Heart Institute Grand Rounds (we listened to an very interesting presentation about a study regarding Interstage home monitoring cardiology fellow from a hospital in Philadelphia ), Case Management Conferences, flight plans, and Pre-surgical Case Conferences. We listened to the plans and management of the cardiac patients and had a chance to compare the way there patients are treated to the way we handle congenital heart diseases in Poland.
We listened to flight plans of several patients, some of the more complex that we remembered where:
-a 29 yo male patient with Alagille syndrome, post liver transplantation in 2000, on immunosuppression, with tetralogy of fallot after several cardiao-surgical interventions (Blalock-Taussing shunt, right ventrical outflow tract reconstruction, ventricular septal defect patch closure, RPA stent dilation, pulmonary vein stent implantation, right ventricle- pulmonary artery conduit, right and left pulmonary artery stent balloon angioplasty) who was admitted due to staph endocarditis, and scheduled for a RV-PA shunt replacement
-a 5 yo girl, with a diagnosis of single ventricular inversion, left sided atrioventricular valve atresia, malposed great arteries, with pulmonary atresia, and VSD. In the [past she had gone through surgeries : atrial septectomy, PDA ligation, patch augmentation of branch pulmonary arteries, post bidirectional Glen procedure and left pulmonary arthroplasty, Left pulmonary artery stent. This time she was admitted for her final one ventricle procedure and underwent a extracardic conduit non-fenestrated Fontane.
– a 3 week old baby boy with newly diagnosed coactration of the aorta with ventricular disfunction, and inguinal hernia, he underwent a CoA repair with end-to-end anastomosis via thoracotomy, was extubated to room air two days post-op and soon after moved to the ACCU.
-a 2 month old girl, with trisomy 21, respiratory failure, with complete common atrioventricular canal defect, with large VSD, small ASD, she was scheduled for atrioventricular septal defect repair with a single patch, PDA closure.
– a 8 day old newborn girl with : double inlet left ventricle, dextro- transposition of the great arteries, coactration of the aorta with moderate isthmus and transverse arch hypoplasia with suspected anomalous origin of right coronary artery from pulmonary artery, and aberrant right subclavian artery. With this complicated heart anatomy the patient was scheduled for surgical repair : the Norwood operation with a 6 mm Sano shunt placement. She was extubated 2 days after surgery, and had an unfortunate complication of an occlusive thrombosis of left subclavian artery.
WEEKS OF MARCH 25-29, APRIL 2-6 – NICU
Starting out our third week at Cincinnati Childrens, and our first week of observer ship in the NICU, we were greeted by Casie Brasher, who gave us a tour of the NICU on the first and fourth floor of the G building. Then we joined a wing charge nurse and for the rest of the day shadowed her.
From our time with the charge nurse we learned a lot about how nurses work in the NICU, she showed us how they plan out work and how they organize nurses assignment according to nurse qualifications. We also got to know a little more about consistent patient care, and the way they organise teams to provide such care. With the charge nurse (Mason) I and my colleague got to see nurses perform bedside procedures such as patient care (diaper changes, skin care, swaddle techniques), PIV placement , PIV dressing changes, admitting patients from hospital transport, admission of patient from OR, hooking up and changing lines and drips. We also saw care for a patient undergoing CVVHDF therapy for renal failure with Carpe Diem dialysis machine – a device that our hospital in Poland is planning on providing of our patients. The bedside nurses explained to us the basis of how to care for such a patient, and it was very reassuring before we start to work with Carpe Diem in IPCZD.
We also took part in an introductory course regarding PALS procedures. As we learned the NICU unit will be implementing PALS instead of NLS in the foreseeable future, and so they are preparing to educate their staff on PLAS procedure before all the nurses and providers are able to get state certified PALS courses. We took part in this short course, and during 40 minutes went over 4 basic life support techniques : chest compressions and airway ventilation, IO access and drugs used during a code, the use of a defibrillator and a short review of irregular heart rhythms. The educators pointed out the differences between PALS and NLS, and had us all practice the procedures.
On our second day we rounded with the NICU’s Orang team .This specific team cares for patients with BPD and PH. On Tuesdays they meet up with the PH team to round together and asses pulmonary hypertension patients. We heard reports about many premature babies dealing with BPD, and PM associated with it. Many of these patients were oxygen dependant , on HFNC or on ventilators, through ETT of tracheostomy’s. A couple patients were being prepared for discharge to PICU or to TTC or home under parents care, so we also observed the process of organising patient discharge, parent education and evaluation for home care.
Our third day was very interesting as well. We started by rounding with the surgical team, and met mostly patients with NEC, post op or awaiting procedure evaluation. The we joined the Yellow team for their rounds. This team takes care of many medically complex patients, but their main focus is neurosurgical and neurological patients. Some of the patients we heard about :
-a post 22 week preemie, with suspected NEC , on CPAP ventilation
-a 5 day old 39 HBG baby, with a history of seizures post subdural haemorrhage
– a patient post SID, with ostomy creation
-a patient with external ventricular drain, awaiting for a ventriculoperitoneal shunt placement due to hydrocephalus
– a trisomy 21 baby girl with ASD and OSP – obstructive sleep apnoea
After rounds we met with clinical instructor Shari Casy and helped set up a simulation. The simulation taking place that day was a HLHS baby delivery insitu. W could watch the simulation take place. This was a very interesting thing to observe, we could see a full simulation setup and learned a little about simulation preparation. These types of activities are quite different than our approach to staff education – simulations are a great way to go over procedures, test equipment and staff preparation ana d help evaluate procedure execution to help prepare for real cases with complex patients in hopes of rising patient safety and care quality. We look forward to try and implement this type of training in our unit and modify medical staff preparation for work. Being able to see how such a simulation is prepared, conducted and evaluated gives us an idea on how to plan simulations in our unit once we get back home.
We also had a chance to spend time with medical educators. We learned a lot about the process of orientation of nurses in the NICU. We looked at education materials regarding bag ventilation, line building, arterial line care. Via e-mail we obtained sum interesting PDF materials to share with our colleagues at home.
The following days we rounded with all the teams of the NICU – red (surgical), bule (BPD), orange, silver and yellow (medical). The patients in the NICU had similar medical problems as the patients in our hospital in Warsaw.
During rounds and talking with attendings got to learn the history of the following patients :
- A 5 week old female, former 34 week infant with trisomy 21, oxygen requiernment, NG feeding, awaiting airway evaluation for hemangioma and sleep study due to sleep apneoa
- A 2 month old female, former 23 week preemie (twin) with grade 4 intraventricular hemorrhage (IVH), now with posthemorrhagic hydrocephalus (PHH), awaiting shunt evaluation , with bronchopulmonary dysplasia (BPD) on 4l of oxygen, and her twin brother with hydrocephalus and BPD
- A 6 week old, former 34 week infant, with ventricular septal defect (VSD), admitted with poor feeding , and awaiting cardiological evaluation
- A 4 week old term male baby with cleft lip and palate admitted on naso-gastric feeding, scheduled for gtube
- A 3 month old female, former 25 week preemie – IUGR, sever with bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), with issues including slow weaning from ventilation, slow growth, ROP evaluation
- A 2 week old 32 weeker, with IUGR and sever aortic coarctation
- A 6 week old male with junctional epidermolysis bullosa (EB), some of his issues included dermatological evaluation and g-tube placement while improving oral feeding skills, and optimizing pain regiment
- A 9 day old baby admitted due to hypothermia, needing additional check ups
- A 2 month old female patient, former 31 week preemie, with posthemorrhagic hydrocephalus (PHH), with ventricular access device, tapped daily, for evaluation for ventriculoperitoneal (VP) shunt, with bronchopulmonary dysplasia (BPD), working on oral feeding skills, and weaning from respiratory suuport
- A 2 month old female baby with bronchopulmonary dysplasia (BPD) post DART protocol, left pulmonary vein stenosis (PVS) and overcirculation from large ASD, with history of NEC needing NG feeds
- A 4 month old baby boy, former 27 week preemie with subglottic stenosis and right nasal synechiae, post several airway dialtions.
We also spent 2 days in the cath lab with dr Hirsch. During our visit he had a couple cases – one was a diagnostic catheterization of a child with PH, the second was the implantation of an occluder in a patient with ASD, and the third was a balloon dilation of a stent in the pulmonary vein, in a child with former stent implantation.
The next day we also spent with dr Hirsch, this time in the pulmonary hypertension clinic. Dr Hirsch was extremely welcoming to us , and shared a lot of his knowledge about BPD, pulmonary hypertension and heart catheterization procedures with us. It was an unique experience for us to see firsthand cath lab procedures taking place, and it gives us a better understanding of what the procedures our patients undergo look like.
We concluded our visit in the NICU with a visit to the OR in the fetal department, top watch a fetal endoscopic myelomeningocele closure.
END THOUGHTS
I am extremely happy to have been given this opportunity to travel to the USA to one of the best hospitals in the country. During our stay we had a chance to talk with a lot of medical staff members. Everyone was extremely welcoming, and always had time to show us around or to answer our questions. We made contacts with many doctors and nurses, exchange emails of future contact.
Watching the way people work in the NICU gave us many ideas to change some things we do, and better organize our work for the benefit of our patients.
For me as a nurse, it was very important to witness the way doctors work, to better understand the processes and work it takes to come to the decisions that they make, and orders that are carried out. I thing its beneficial for both nurses and doctors to see each other’s work , so that we can appreciate and understand each other. This will help us build a better team, and allow for better information flow and patient care.
An important thing that we observed in the hospital was a very deeply implemented patient centred care plan. The patient and the families were involved in all the rounds, were informed about everything and could be with the patient all the time. I think we have a lot to improve in this area of patient care in Poland and that everyone from our institute is keen on changing our way we deal with patients families.
A couple of ideas that we have regarding changes in our unit include
-better organization of assessment and patient care
-better communication between nurses and doctors
-more organized (maybe with the use of flowsheets) patient handoff and report giving
-better documentation of procedures
-improvement of communication with family members and working on providing a calm and welcoming atmosphere in the unit both for staff and patients with their families.
With kind regards, Dominika Niedziałek
Dominika Niedziałek
Children’s Memorial Health Institute, Warsaw, Poland
Nurse, at the Neonatology, newborn and infant pathology and intensive care unit
Report of the Observership in Cincinnati Children’s Hospital
The aim of this report is to present the Observership at Cincinnati Children’s Hospital which I had got the pleasure to take part in from March 10th to April 5th. I spent 2 weeks in Cardiac Intensive Care Unit (CICU) and 2 weeks in Neonatal Intensive Care Unit (NICU). Our internship program involved division into pairs consisting of a doctor and a nurse, so I spent this month with the nurse: Dominika Niedziałek. Because of the fact that we are working in various position we had a broader view on everything that we looked at.
Both in the CICU and in the NICU we observed the process of managing patient care. We were interested in the way patient care is handled by all the staff members. Differently than in Poland, all the medical staff (the dietician, the pharmacist, the respiratory therapist, the nurses and the doctors: fellows and attendings) together asses the patients problems and decide on the treatment plan. Every person takes care of their field of expertise.
During the first two weeks we had opportunity to observe work in CICU. We participated in Surgical and Clinical Rounds with the attending doctors: David S. Cooper, Alexis Benscoter, Katja Gist, and Meghan Chlebowski, and their fellows. For the most part the patients of the CICU were infants with congenital heart diseases (before and after repair) including: HLHS, TGA, VSD, ASD, CoA, PH, TVR, MVR, and many other conditions that led to heart failure. There were also patients on VAD’s including: BERLIN hearts, impala devices, heart mates, and some on ECMO treatment awaiting transplantation either of the heart or the heart and lungs. We listened to the plans and management of the cardiac patients and had a chance to compare the way there patients are treated to the way we handel congenital heart diseases in Poland. Thanks to the kindness of dr. Hirsch we had an opportunity to look at procedures in Cardiac Cath Lab and see long-term outcomes of Patients in the Pulmonary Hypertension Clinic.
We took part in CICU Heart Institute Grand Rounds (we listened to an very interesting presentation about a study regarding home monitoring), case management Conferences, flight plans and Pre-surgical case Conferences.
The next two weeks we spent in NICU. Early mornings were devoted to Clinical Rounds, we had the possibility to follow different teams (there were 5 teams) working with different patients (surgical, those with bronchopulmonary dysplasia, renal insufficiency, hydrocephalus). We also observed the process of organising patient discharge, parent education and evaluation for home care.
What’s more we spent almost all one day with charge nurse where we learned a lot about how nurses work in the NICU looks like. She show us how they plan out work and how they organize nurses assignment according to nurse qualifications. We observed nurses perform bedside procedures such as patient care (diaper changes, skin care, swaddle techniques), PIV placement , PIV dressing changes, admitting patient from outside hospital transport, addition of patient from OR, hooking up and changing lines and drips. We also saw care for a patient undergoing CVVHDF therapy for renal failure with Carpe Diem dialysis machine – a device that our hospital in Poland is planning on providing of our patients.
We also took part in an introductory course regarding PALS procedures – we went over 4 basic life support technics: chest compressions and airway ventilation, IO access and drugs used during a code, the use of a defibrillator and a short review of irregular heart rhythms.
We had chance to work with clinical instructor Shari Casy and helped her set up a simulation. The simulation taking place that day was a HLHS baby delivery insitu. We could see a full simulation setup and learned a little about simulation preparation. We look forward to try and implement this type of training in our unit and modify medical staff preparation for work. Being able to see how such a simulation is prepared, conducted and evaluated gives us an idea on how to plan simulations in our unit once we get back home.
We also had a chance to spend time with medical educators. We learned a lot about the process of orientation of nurses in the NICU.
During whole stay we could discuss clinical questions with attendings, fellows and nurses, who passionately and willingly shared their knowledge.
The organization of work and teaching both in the Heart Institute and in the NICU is unique and inspiring. We’ve seen a lot of things that inspired us to make changes in our Unit.
Kind Regards,
Aleksandra Pietrzyk
Children’s Memorial Health Institute
Aleja Dzieci Polskich 20
Warsaw, Poland
Report
From January 15th to February 11th 2024 I had the opportunity to attend a clinical observership at Cincinnati Children’s Hospital Heart Institute and Newborn Intensive Care Unit.
On the first day we were welcomed by Jennifer Blair Immigration Services Alternative Responsible Officer who showed us around the hospital, introduced us to Teresa Racke Senior Executive Assistant to Michael Gaies, MD, MPH, MSc,The Heart Institute. She prepared us a script with the most important information about the institute and a plan for our stay. The plans included: H.I. conferences and pediatric grand rounds which we attended in the following days. We also meet Ivan Wilmot, M.D Professor of Clinical Pediatrics, Director, Cardiology Fellowship program.
During our stay at CICU, we had the opportunity to participate in grand rounds every day and observe work directly with patients.
Next two weeks we spent in the Newborn Intensive Care Unit.
On the first day we were welcomed and shown around by Michelle Shinkle MSN, RN, Clinical Director, who then gave us the itinerary for our stay. It contained: Time with a charge nurse, HAC refresh class, time with bedside RN, time with CLABSI champion and clinical coach. We also participated in fetal consults, medical simulations with an educator and rounds.
This opportunity to participate in international observations gave me a lot of both practical and substantive knowledge. Every day in my department I work with newborns and premature babies, including those requiring cardiac surgery and post operative care. Thanks to this visit, I learned about new possibilities of care and therapy, gaining a lot of inspiration and ideas for changes in our Unit. I am convinced that the experience gained during the internship will be useful to me in my future career. I am very grateful to the Foundation for helping me complete this internship.
Kind regards,
Patrycja Jędruchniewicz
Nurse at the Neonatology and Neonatal Intensive Care Department at Children’s Memorial Health Institute, Warsaw, Poland
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Dariusz Gruszfeld, M.D.,
Work Location: Children’s Memorial Health Institute
Specialty: Pediatric Surgeon
Training Period: 2024
Training Location – Children’s Hospital in Cincinnati
Janusz Bohosiewicz, M.D.
Work Location: Silesian Academy of Medicine
Specialty: Pediatric Surgeon
Training Period: 1991
Training Location – Children’s Hospital in Boston
Janusz Bursa, M.D.
Work Location: Silesian Academy of Medicine
Specialty: Neonatology/Pathology
Training Period: 1988
Training Location: UCLA,USC – Harbor General Hospital
Piotr Czauderna, M.D.
Work Location: Medical Academy Gdansk
Specialty: Pediatric Surgery
Training Period: 1991
Training Location: UCLA Medical Center
Iwona Domzalska-Popadiuk, M.D.
Work Location: Medical University of Gdansk
Specialty: Neonatology
Training Period: 1994
Training Location: University Hospital in Zurich
Katarzyna Drabko, M.D.
Work Location: Children’s Hospital in Lublin
Specialty: Pediatric Hematology/Oncology
Training Period: 2002
Training Location: Los Angeles Children’s Hospital
Ewa Gorczynska, M.D. ,Ph.D.
Work Location: University Hospital, Wroclaw
Specialty: Hematology/Oncology
Training Period: 2005
Training Location:Chicago Children’s Memorial Hospital
Wojciech Grzywna, M.D.
Work Location: Silesian Academy of Medicine in Katowice
Specialty: Neonatology/Pathology
Training Period: 2005
Training Location: Hopital Trousseau, Paris
Jerzy Harsymczuk, M.D.
Work Location: Karol Marcinkowski University of Medical Sciences
Specialty: Pediatric Surgeon
Training Period: 1997
Training Location: UCLA
Ewa Homa, M.D.
Work Location: Regional Hospital NO.2 in Rzeszow
Specialty: Neonatologist
Training Period: 2002
Training Location: Women and Infants Hospital, Providence RI.
Iwona Janczewska, M.D.
Work Location: Pomeranian Medical University of Szczecin
Specialty: Neonatology
Training Period: 2010
Training Location: Columbia University Medical Center, New York
Anna Jaworska, M.D.
Work Location: Karol Marcinkowski, University of Medical Sciences in Poznan
Specialty: Neonatology
Training Period: 2006
Training Location: USC
Piotr Kalicinski, M.D.
Work Location: Children’s Memorial Health Institute, Warsaw
Specialty: Pediatric Surgery/Transplantation
Training Period: 1988
Training Location: UCLA and University of Pittsburgh
Barbara Kassur-Siemienska, M.D.
Work Location: Children’s Memorial Health Institute, Warsaw
Specialty: Pediatric Nephrology
Training Period:1991
Training Location: UCLA
Jacek Kijowski, M.D.
Work Location: National Research Institute of Mother and Child
Specialty: Pediatric Oncology
Training Period: 2002
Training Location: New York-Presbyterian Hospital of Columbia University
Irena Makulska, M.D.
Work Location: Wroclaw Medical University
Specialty: Pediatric Nephrology
Training Period: 1996
Training Location:Children’s Medical Center at Stony Brook
Jolanta Meller ,M.D.
Work Location: Province Hospital, Elblag
Specialty: Neonatologist
Training Period: 1998
Training Location: USC, LACH
Barbara Michalczyk, M.D.
Work Location: Pomeranian Medical University of Szczecin
Specialty:Neonatology
Training Period: 2013
Training Location:Miami Children’s Hospital
Jerzy Niedzielski, M.D.
Work Location: Medical Academy of Lodz
Specialty: Pediatric Surgery
Training Period: 1993
Training Location: Babies Hospital, Columbia – Presbyterian Medical Center
Dariusz Patkowski, M.D.
Work Location: Medical Academy of Wroclaw
Specialty: Pediatric Surgery:
Training Period: 1993
Training Location: Columbia University Babies Hospital in New York
Anna Piaseczna Piotrowska, M.D., Ph.D.
Work Location: Polish Mother’s Health Institute
Specialty: Pediatric Surgery
Training Period: 2002 -2003
Training Location: Our Lady’s Hospital for Sick Children, Dublin Ireland
Barbara Piatosa, Ph.D.
Work Location: Children’s Memorial Hospital, Child Health Center
Specialty: Neonatology/Pathology
Training Period: 1990
Training Location: University of California Los Angeles. read more
Iwona Domzalska-Popadiuk, M.D.
Work Location: Medical University of Gdansk
Specialty: Neonatology
Training Period: 1994
Training Location:University Hospital in Zurich read more
Anna Raciborska, M.D.
Work Location: Institute of Mother and Child Warsaw
Specialty: Pediatric Oncology
Training Period: 2007, 2012, 2007
Training Location: Children’s Hospital Los Angeles, St Judes Children’s Research
Maria Roszkowska-Blaim, M.D.
Work Location: Academy of Medicine in Warsaw
Specialty: Pediatric Nephrology
Training Period: 1990
Training Location: UCLA
Jacek A. Rudnicki, M.D. (Polish Report)
Work Location: Military Academy of Medicine Szczecin
Specialty: Neonatologist
Training Period: 1988
Training Location: UCLA Medical Center,USC and Harbor/UCLA School of Medicine
Tomasz Sioda, M.D. (Polish Report)
Work Location: Academy of Medicine Poznan
Specialty: Neonatologist
Training Period: 1986
Training Location: USC, UCLA, USC Harbor
Czeslaw Stoba, M.D.
Work Location: Medical Academy of Gdansk
Specialty: Pediatric Urology
Training Period: 1985
Training Location: UCLA
Bogdan Stodulski, M.D., Ph.D
Work Location: Children’s Memorial Health Institute, Warsaw
Specialty: Pediatric Surgeon
Training Period: 1992
Training Location: Harvard Medical School,
Janusz Swietlinski, M.D. (Polish Report)
Work Location: Silesian Academy of Medicine Katowice
Specialty: Anesthesiologist
Training Period: 1992
Training Location: Babies Hospital, Columbia – Presbyterian Medical Center
Joanna Szymkiewicz, M.D.
Work Location: Children’s Memorial Health Institute, Warsaw
Specialty: Pediatric Cardiology,
Training Period: 1994
Training Location: Children’s Hospital, Boston
Dominik Turkiewicz, M.D.
Work Location: Wroclaw University of Medicine
Specialty: Pediatric Oncology/Hematology
Training Period:2001
Training Location: St Judes Children’s Research Hospital, Memphis
Irena Wojsyk-Banaszak, M.D.
Work Location: Poznan University of Medical Sciences
Specialty: Neonatologist
Training Period: 2003
Training Location: UC Davis Medical Center,
Joanna Zawitkowska-Klaczynska, M.D.
Work Location: University Children’s Hospital of Lublin
Specialty: Pediatric Oncology,
Training Period: 2001
Training Location: Children’s Hospital