Skip to main content

Advertisement

SpringerLink
Log in

Assuring safe patient care in a level III NICU in anticipation of hospital closure

  • Quality Improvement Article
  • Published:
Journal of Perinatology Submit manuscript

A Correction to this article was published on 23 April 2020

This article has been updated

Abstract

Objectives

Hospital closures promote latent factors putting patients at risk for medical errors. Our goal was to maintain safe patient care in our Neonatal Intensive Care Unit (NICU) by preventing any increase in neonatal mortality or hospital-based complications prior to hospital closure.

Methods

Interventions included expanding TeamSTEPPS huddles and Leadership WalkRoundsTM. Measurements of safety domains were conducted using the Safety Attitudes Questionnaire. A run chart tracked neonatal mortality. We compared hospital-based complications for all neonatal admissions in 2019 with our own past outcomes.

Results

Teamwork climate scores increased from an average score of 24.6–28.3 (maximum score 30, P < 0.05, CI 6.7–0.9). Quarterly neonatal mortality and neonatal outcomes did not worsen. The frequency of transfer did not increase.

Conclusions

A strong teamwork climate with resilient leadership may mitigate safety concerns under calamitous circumstances.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1: A Fishbone diagram detailed domains of patient safety and how they effect neonatal outcomes during a hospital-wide reduction in services.
Fig. 2: Primary outcome measure of neonatal mortality displayed quaterly.
Fig. 3: Process measure displayed as individual domains and average score on Safety Attitudes Questionnaire. N = number who took survey that month.
Fig. 4: Balancing measure of neonatal hospital-to-hospital transfers displayed monthly as Statistical Process Control X-charts with annotations about service delivery.

Similar content being viewed by others

Change history

References

  1. Institute of Medicine (US) Committe on Quality of Health Care in America. To Err is Human: Building a Safer Health System. In: Kohn LT, Corrigan JM, Donaldson MD editors. Washington, DC: National Academy Press; 2000.

  2. Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. BMJ 1998;316:1154–7.

    Article  CAS  Google Scholar 

  3. Bishop G. Childbirth at a crossroads in Southeastern Pennsylvania. Philadelphia, PA: Maternity Care Coalition; 2006.

  4. Lorch SA, Srinivas SK, Ahlberg C, Small DS. The impact of obstetric unit closures on maternal and infant pregnancy outcomes. Health Serv Res. 2013;48:455–75.

    Article  Google Scholar 

  5. Lorch SA, Martin AE, Ranade R, Srinivas SK, Grande D. Lessons for providers and hospitals from Philadelphia’s obstetric services closures and consolidations, 1997-2012. Health Aff. 2014;33:2162–9.

    Article  Google Scholar 

  6. Rush M. Hahnemann University Hospital’s inner turmoil: a timeline of changes, layoffs, and closings Philadelphia Inquirer. 2019. https://www.inquirer.com/business/health/hahnemann-university-hospital-closing-timeline-20190626.html.

  7. Clancy CM, Tornberg DN. TeamSTEPPS: assuring optimal teamwork in clinical settings. Am J Med Qual. 2007;22:214–7.

    Article  Google Scholar 

  8. Sexton JB, Sharek PJ, Thomas EJ, Gould JB, Nisbet CC, Amspoker AB, et al. Exposure to Leadership WalkRounds in neonatal intensive care units is associated with a better patient safety culture and less caregiver burnout. BMJ Qual Saf. 2014;23:814–22.

    Article  Google Scholar 

  9. Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6:44.

    Article  Google Scholar 

  10. Vermont Oxford Network. Definition of chronic lung disease. 2019. https://nightingale.vtoxford.org/help/!SSL!/WebHelp/CLD36.htm.

  11. Provost LP, Murray S. The health care data guide: learning from data for improvement. San Francisco, SA: Jossey-Bass Publishers; 2011.

    Google Scholar 

  12. Coleman-Lochner LaJH. Hospital bankruptcies leave sick and injured nowhere to go. 2020. https://www.bloomberg.com/news/articles/2020-01-09/hospital-bankruptcies-leave-sick-and-injured-nowhere-to-go?cmpid=BBD010920_BIZ&utm_medium=email&utm_source=newsletter&utm_term=200109&utm_campaign=bloombergdaily.

  13. Mosley DaDD. Rural hospital sustainability: new analysis shows worsening situation for rural hospitals, residents. 2019. https://www.navigant.com/-/media/www/site/insights/healthcare/2019/navigant-rural-hospital-analysis-22019.pdf.

  14. Kübler-Ross E. On death and dying. . New York: Macmillan; 1969. 260 viii.

    Google Scholar 

  15. Communications DoC. The essential role of leadership in developing a safety culture. The Joint Commission. 2017.

  16. Smith JR, Wolf M. Resiliency: a core competency in today’s NICU nurse leader. J Perinatol Neonatal Nurs. 2018;32:295–6.

    Article  Google Scholar 

  17. Leape LL. Error in medicine. JAMA 1994;272:1851–7.

    Article  CAS  Google Scholar 

  18. Braithwaite J, Wears RL, Hollnagel E. Resilient health care: turning patient safety on its head. Int J Qual Health Care. 2015;27:418–20.

    Article  Google Scholar 

  19. Wears RL, Hollnagel E, Braithwaite J. The resilience of everyday clinical work. Farnham, Surrey; Burlington, VT: Ashgate; 2015. 295 xxix

    Google Scholar 

  20. King ML. The measure of a man. Philadelphia: Christian Education Press; 1959. 34.

    Google Scholar 

Download references

Acknowledgements

Dr Harbhajan Chawla was one of the early trainees in Neonatal Medicine at the University of Pennsylvania. After his fellowship, he took on the responsibility for Newborn Services at Hahnemann University Hospital and never left. Over his 46 years of service to Hahnemann, Chawla became a legendary teacher, mentor, clinician, and colleague. He championed the role of regional neonatal resuscitation instructor, has been honored with numerous teaching awards, and has the rare and esteemed distinction of being a tenured faculty member of the Drexel University College of Medicine. On July 15, 2019, he stood beside a dedicated nursing staff, and saw that the last few patients were safely transferred and discharged from Hahnemann’s NICU and well-baby nursery. “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy [20].”

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, St. Christopher’s Hospital for Children and Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, PA, USA

    Rachel Fleishman, Endla Anday & Vineet Bhandari

  2. Albert Einstein Medical Center, Philadelphia, PA, USA

    Rachel Fleishman

  3. Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA

    Rachel Fleishman

  4. Abington Hospital – Jefferson Health, Abington, PA, USA

    Endla Anday

  5. The Children’s Regional Hospital at Cooper, Camden, NJ, USA

    Vineet Bhandari

  6. Cooper Medical School at Rowan University, Camden, NJ, USA

    Vineet Bhandari

Authors
  1. Rachel Fleishman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Endla Anday
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vineet Bhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RF conceptualized and designed the study, administered and scored the Safety Attitudes Questionnaire, performed the data analyses, drafted the initial article, and approved the final article as submitted. EA championed staff teamwork and morale-boosting activities with the assistance of other senior faculty, oversaw the administrative data collection for all outcomes measured and reported in this paper, and critically reviewed and edited the final article as submitted. VB assisted in conceptualizing the study design, supported and led efforts to champion staff teamwork and morale-boosting activities with the assistance of other senior faculty, and critically reviewed and edited the final article as submitted.

Corresponding author

Correspondence to Rachel Fleishman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. Vermont Oxford Network played no role in the study design, conduct, analysis, interpretation, or reporting. The views, conclusions, and opinions expressed are solely those of the authors and do not represent those of the Vermont Oxford Network.

Ethical approval

Safety culture reflects a collaborative effort of all providers and administrators to assure exceptional patient care. No patients were randomized, no interventions involved comparison of therapies, and no medical records were reviewed by authors beyond the scope of daily patient care and routine administrative tasks. The Drexel University Institutional Review Board granted exemption.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleishman, R., Anday, E. & Bhandari, V. Assuring safe patient care in a level III NICU in anticipation of hospital closure. J Perinatol 40, 1719–1725 (2020). https://doi.org/10.1038/s41372-020-0648-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-020-0648-7

  • Springer Nature America, Inc.

Search

Navigation