A Vanderbilt University Medical Center News and Public Affairs Publication GIVING / CHILDREN'S HOSPITAL / VANDERBILT UNIVERSITY
Vanderbilt Childrens Hospital
... on their way

In this issue: SUMMER 2010

Welcome letter
Big dreams for tiny babies
The thrill of discovery
A joint effort
Born too soon
The nature of nurture
Steeplechase benefits Children's Hospital
Friends and fashion



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A joint effort

Sharing for the sake of caring

By Carole Bartoo / June 2010

Carla Saunders, N.N.P., with Garrett Layman. Photo by Joe Howell.Carla Saunders, N.N.P., with Garrett Layman. Photo by Joe Howell.Two years ago, Carla Saunders, N.N.P., a 20-year veteran neonatal nurse practitioner, decided to do something about the high rates of central line infections at her hospital.

“We do not accept an infection as the cost of doing business,” Saunders said.

As the advanced care coordinator in the Pediatrix Medical Group’s neonatal service at East Tennessee Children’s Hospital in Knoxville, Saunders worked hard on a plan to reduce infections in the Neonatal Intensive Care Unit (NICU).

Ultimately, the plan succeeded. It reduced central line infections by an amazing 85 percent.

That sort of success is very good for a hospital. The public increasingly scrutinizes quality indicators like infection rates, and comparison shops for quality hospital care. But competitive edge is not what Saunders was looking for. Instead, her goal was to find a way to share her success.

Saunders and her colleagues found that way to share in the brand new Tennessee Initiative for Perinatal Quality Care (TIPQC). East Tennessee Children’s infection reduction project was completed just in time to share it (happily) with competitors and NICUs across the state, as part of TIPQC.

“No matter what a great job we do at our own hospitals, it won’t move the statistics a lot. We need to share what we do with others, and we need to learn from each other,” said Judy Aschner, M.D., Julia Carell Stadler Professor of Pediatrics and director of the Mildred Stahlman Division of Neonatology in Vanderbilt’s Department of Pediatrics.

TIPQC was Aschner’s brainchild. Other states, like California, Ohio and North Carolina, already had neonatal/perinatal care collaboratives. She went to the Governor’s Office of Children’s Care Coordination (GOCCC) and the March of Dimes to find funds to start one in Tennessee.

The collaborative officially got off the ground in late 2008. Medical Director Peter Grubb, M.D., said the goal for TIPQC is simple. Take the energy and initiative exhibited by people like Carla Saunders use it to devise evidence-based practices that can improve care, and then selflessly share with everyone.

“The air transportation industry adopted a non-competitive approach to flight safety some time ago. Not sharing to gain a competitive advantage has become unthinkable. This ideal resonates with many stakeholders across the health care spectrum, and organizations like TIPQC provide a previously missing venue to share data and experience about patient safety and quality,” said Grubb.

Saunders says it is about time.

“We have been good at sharing results of research for some time, but we have not been good at sharing quality improvement information. Maybe the lack of sharing was competition or fear based,” Saunders said.

After only one year of operation, TIPQC has more than 1,000 individual members, including nurses and physicians from groups representing all 27 NICUs in Tennessee, plus a growing number of Obstetrics/Gynecology practices hoping to improve the prenatal half of the equation for giving babies a healthy start.

And it’s not just turning away from business-type competition. Within TIPQC, there is a palpable lack of credit-taking as well. Grubb and Aschner acknowledge Vanderbilt was instrumental in the launch of the collaborative model, but they emphasize everyone’s goal is better care for babies and TIPQC members are absolute equals in sharing insights, leadership and bright ideas. No one is laying claim to the best or brightest ideas either. Even Saunders fully credits others for her successful infection control plan.

“The California Perinatal Quality Care Commission (CPQCC) had a very successful program to prevent the spread of infectious agents through catheters like central lines. We figured, why re-invent the wheel?” she said.

Saunders simply boiled down California’s book and created a simplified toolkit. Then on Jan. 22 of this year, 12 the TIPQC-member NICUs began their own projects using East Tennessee Children’s toolkit and guidance. The immediate aim of that project: reduce central line infection rates in NICUs by 50 percent within the first year.

This trend away from the business-model culture of competition and toward a culture of sharing and transparency is well timed. There are increasing demands for transparency in Tennessee and nationwide. A study by the state health department recently detailed Tennessee’s central line infection rates in both adults and children. Tennessee infection rates sit atop the national averages. That report received quite a bit of media attention and included observations that actions as simple as careful hand washing can greatly reduce the risk for infection, yet simple, evidence-based plans have been frustratingly difficult to implement across all hospitals.

Saunders hopes TIPQC’s program, based on coordinated sharing of quality improvement programs, will be the first to succeed in a big way.

“It is exciting because we should be learning from each other’s mistakes and successes,” Saunders said. “Some people might not have the staff and people to do what we did with the California plan, so we break it down and help them along the way.”

“The time is right,” said Grubb. “We have had multiple opportunities to do the right things in the past and failed to take them. But the culture is changing. Now we’re taking those opportunities.”





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Friends and fashion By Kelly Archer

Steeplechase benefits Children's Hospital By Jessica Ennis

The nature of nurture By Jessica Ennis