384 - STEPP IN (Safe Transitions & Euthermia in the Perioperative Period in Infants & Neonates) Next Steps: Quality Improvement Enhances Team Culture of Safety

Poster Number: 384
Publication Number: 384.434

Eugenia Pallotto, Levine Children's Hospital, Charlotte, NC, United States; Anthony J. Piazza, Emory University School of Medicine, Atlanta, GA, United States; John Chuo, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Melissa Duran, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Theresa Grover, University of Colorado School of Medicine, Aurora, CO, United States; Gustave Falciglia, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Judith Hawes, The Hospital for Sick Children, Brampton, ON, Canada; Teresa Mingrone, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Priscilla Joe, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Natalie Rintoul, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Thomas Bartman, Nationwide Children's Hospital, Columbus, OH, United States; Richard E. McClead, Nationwide Children's Hospital, Gahanna, OH, United States; Aaron P. Rose, Children's Hospitals Neonatal Consortium, Lexington, KY, United States; Khatija Naing, University of Illinois College of Medicine, Chicago, IL, United States; Mary Jo L. MacPherson, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Beverly Brozanski, Washington University in St. Louis School of Medicine, St Louis, MO, United States

Background: The Children’s Hospitals Neonatal Consortium (CHNC) STEPP IN Next Steps collaborative was designed to optimize postoperative physiologic parameters by focusing on inter-disciplinary perioperative team handoff (HO). The project action period was Nov. 2017-Dec. 2018 and project sustain period: Jan.-Dec. 2019. Poor perceived safety culture is linked to increased error rates. This collaborative provided a unique opportunity to foster a culture of safety within and across teams caring for the neonatal patient during the perioperative period.

Objective: To evaluate the impact of inter-disciplinary quality improvement on team safety culture during perioperative handoff in the neonatal intensive care unit (NICU).

Design/Methods: A cross-sectional survey of collaborative site leaders was distributed to 24 participating centers at five time points: three times during the collaborative action period (at baseline, 6 and 12 month); during the 12 month sustain period and 4 months after the sustain period was completed.  Four questions were adapted from the Agency for Healthcare Research and Quality's (AHRQ) hospital safety survey were adapted for this project. The questions evaluated communication during transfer of care, teamwork and overall patient safety specifically related to perioperative process and perioperative handoff and included. “Please give Your work area/unit in the hospital an gverall grade for patient safety”; “Things ‘fall through the cracks’ when transferring patients between units”; “There is good cooperation between hospital units that need to work together”; and "Problems often occur in the exchange of information across hospital units".

Results: Leaders from 23 participating centers participated. 242 survey responses were analyzed. Baseline assessment was in Nov 2017 and the post sustain assessment in April 2020. Overall patient safety grade of excellent or very good remained stable (86.2 to 90%, p=NS). There was an increase in respondents disagreeing or strongly disagreeing that things fall through the cracks from a baseline of 41.4% to 76.7% post-sustain period (p=0.001). Strong agreement that good cooperation existed between units and strong disagreement that problems occur between exchange of information also increased (8.6% to 46.7%, p=0.001; and 6.9% to 26.7%, p=0.03, respectively). Conclusion(s): Achieving sustained improvements in safety culture can be difficult. Collaborative quality improvement efforts can lead to measurable improvements in safety culture that sustain beyond the collaborative project action and sustain period.