Start with a Sense of Trust

Communication Tool Improves Outcomes

It started as a wall covered in sticky notes. Two years later, it’s a communication tool that is improving outcomes for some of Children’s Hospital Colorado’s most complex patients. And it was accomplished, thanks to the dedication of a multidisciplinary team which included members across several units and specialties, including Elisa Benefield, RN (spine nurse), Lisa McLeod, MD, MSCE​,  Mindy Cohen, MD​ (anesthesiology), Rachel Fisherkeller, NP (ICU) and Jessica Cataldi, MD (infectious disease fellow) (pictured left to right, above). 

Dr. McLeod led the team as they took a critical look at the process a patient goes through when having orthopedic surgery, tracking every step from operating room to intensive care. The team took a close look at the patient population, and found in some cases the ICU was needing to take extensive measures to keep a patient’s blood pressure up post surgery. 

“We decided that maybe this shouldn’t be something that just happens,” she said. “Once we started to take a closer look, we realized the general lack of understanding we had of one another’s jobs.”

Thanks to her training with the Institute for Healthcare Quality, Safety and Efficiency (IHQSE), Dr. McLeod knew that the first step in the process was establishing a sense of trust. 

“It took a lot of relationship building and getting integrated into the orthopedics’ pediatric clinics. We had to first understand the process, then focus on the needs of this patient group,” she said. “We also needed to demonstrate the leadership team’s investment in the project. Part of this was recognizing our interdependence on each other.”

Yet even after they understood the process and many roles involved with a patient’s care, Dr. McLeod’s team couldn’t find the exact answer as to why some patients needed intensive post-surgery interventions. The team concluded that what was lacking was communication—and determined if the entire multidisciplinary team communicated better, they could be better prepared to care for the patients as they moved through the hospital. 

The team developed a communication tool aimed at giving the many players—surgeons, anesthesiology, and post-operative caregivers—moment to moment updates. The tool allowed the ICU to view the patient’s progress in real time, which helped them to be prepared for any necessary interventions once the patient was transferred into their care. 

Feedback from the entire team was essential in creating a tool that was helpful for all parties and didn’t take up too much of the team’s time. The written communication tool went through several iterations. 

“As we tried out different versions, we wanted to know what interfered with workflow: Was it too long? Was this piece not important? And each time we made a change, we wanted to know how it might impact everything else.” 

Branding the Platform

Dr. McLeod believes another key to the team’s success was following a concept learned in the IHQSE called “The Burning Platform.” 

“We had to prove first that there was a problem, and make solving that problem stick in everyone’s head. To do so, we needed to brand it. We came up with CRASH Care, which stood for Collapse Resuscitation and Sudden Heightening of Care. By branding our efforts, people stayed motivated and wanted to improve. It helped us build endurance.”

Improving Outcomes

Dr. McLeod and her team have reduced the proportion of patients needing significant acute resuscitation and escalation of care in the post-operative period. They also hope to demonstrate shorter PICU stays by the end of 2016. 

Dr. McLeod believes much of the credit belongs with the group. 

“It can be difficult to break down the dogma, how people have done things for years and years,” she explained. “Overall, we have such a great group. They’ve been willing to listen and make changes to see if we can improve things.” 

Dan Hyman, MD​, chief quality officer at Children’s Hospital Colorado, believes Dr. McLeod’s team should also be congratulated on creating a program that can be replicated in other disciplines. 

“I’m so proud of this team,” said Dr. Hyman. “The best part was seeing how, under Dr. McLeod’s leadership, the team is taking the principles they have learned and brought into the OR and already seeking ways it can be extended to other patients. Ultimately, that is what IHQSE and CTP specifically are seeking to do.”