In January 2007, St. Louis Children’s Hospital (SLCH) launched an initiative designed to support the hospital’s mission of “doing what’s right for kids” through improved patient safety and clinical quality. The Unit-Based Joint Practice concept encouraged a sense of urgency in achieving these improvements—a strong message for a pediatric hospital already ranked among the America. According to F. Sessions Cole, MD, SLCH’s chief medical officer, that top ranking is exactly why urgency is so important.
“We are all proud as a hospital and as individual units of the great quality of care we provide and the unambiguous commitment to patient safety we have,” he explains. “But with technologies and approaches to both treatment and diagnosis constantly changing, we need to challenge ourselves daily to ensure we are enhancing how we care for patients and keep them safe.”
Today, that urgency to improve is being carried out by 17 unit-based joint practice teams throughout the hospital working to accomplish four major goals:
- enhance family-centered care
- improve transitions in care
- improve response to deteriorating patients
- improve teamwork
Each team has a physician and nurse leader and is comprised of representatives from disciplines that work closely with a particular unit, as well as parents who bring a totally different perspective on patient care.
“The intent was to promote more collaborative practices between the medical and hospital staffs, with patient-focused care being at the core,” says Peggy Gordin, RN, MS, vice president, patient care services. “The unit-based joint practice teams have absolutely modeled collaboration and fostered more collegial relationships among the nursing and medical staffs and other disciplines throughout the hospital. The improvements we are seeing could not have taken place without the communication and cooperation that has developed from these teams identifying challenges, researching solutions and then taking the steps necessary to put new procedures in place.”
The teams’ efforts are supported with leadership training, coaching, and quality improvement liaisons who help team members interpret data and focus their efforts for maximum outcomes. Among the many improvements made are:
§ the Rapid Response Team, which brings ICU clinicians as early as possible to the bedside of regular ward patients whose conditions are beginning to deteriorate
§ mock codes conducted on units to improve response
§ parents participating in daily rounds on 8 East and in the PICU
§ a smooth transition of care for asthma patients transferred from the emergency unit to the nursing unit
§ earlier delivery of medications for children being discharged from same-day surgery
“The enthusiasm and commitment of the joint practice teams—and the ideas coming forth as a result—are terrific. There is a sense of ownership that has truly enhanced this initiative,” says Dr. Cole.
The success of the nursing unit teams has prompted non-nursing hospital areas to form their own teams, among them the pediatric radiology division.
“Although it’s not an explicitly stated goal of the unit-based joint practice initiative, the communication resulting from these collaborative efforts serves to break down the silos we all create for ourselves,” says Robert McKinstry, MD, PhD, SLCH radiologist-in-chief. “It’s natural for people to become focused on their individual areas without understanding or appreciating the broader interconnection that exists throughout the hospital.”
Dr. McKinstry points out that those interconnections are especially important in areas such as radiology, which also provides vital services in collaboration with other units. To tackle the complicated issues that sometimes arise, Paula Vise, director of the Joe Buck Imaging Center and team co-leader with Dr. McKinstry, formed subteams to focus on the Emergency Unit, MRI and the department’s internal quality improvement.
“Prior to forming these subteams, we didn’t have an avenue through which we could really talk with other departments to discover, for instance, why it was difficult for them to get patients to us on time, or for them to know why it was important for us to know ahead of time when patients were being sent for imaging studies,” says Vise. “We’d tell each other our problems but really didn’t understand the processes that were contributing to the difficulties.”
Sitting down with physicians, nurses and other health care professionals from throughout the hospital has uncovered both reasons and solutions. “Our subteams are still in the early stages, but we’ve already worked with the EU on a way to communicate better about patients needing radiology services, and we’re looking into an automated ordering system that should be of great benefit to us and the departments we serve,” says Vise.
Multiple unit-based joint practice teams meet three times a year to share their successes and learn more about ways they can advance SLCH’s family-centered care concept. “Focusing on the family is an integral part of St. Louis Children’s Hospital’s culture. Through the unit-based joint practice teams, we are providing an infrastructure that can support our culture’s continual development in responding to our patients and their families,” says Dr. Cole.
Unit-Based Joint Practice Team Leaders
Community physicians who have a concern or question regarding patient care at St. Louis Children’s Hospital may contact the leaders in the following areas (all phone numbers are in the 314 area code).
Team: EU
Physician Leaders
David Jaffe, MD, 454.2341; jaffe@kids.wustl.edu
Kim Quayle, MD (leader), 454.2824; quayle@kids.wustl.edu
Non-Physician Leader
Linda Robert , 454.2378; lfr1123@bjc.org
TEAM NICU
Physician Leaders
Aaron Hamvas, MD, 454.4683; annd@bjc.org
Amit Mathur, MD, 454.4031; mathur_a@kids.wustl.edu
Non- Physician Leader: Ann Donze, 454.6148; hamvas@kids.wustl.edu
TEAM PICU
Physician Leaders
Allan Doctor, MD, 454.2527; doctor@wustl.edu
Nikoleta Kolovos, MD (leader), 454.2527; kolovos_n@kids.wustl.edu
Non-Physician Leader: Maria Fernandez, 454.4124; mariaaf@bjc.org
TEAM CICU
Physician Leaders
Allan Doctor, MD, 454.2527; doctor@wustl.edu
Paul Checchia, MD (leader), 454.2527; checchia_p@kids.wustl.edu
Non-Physician Leader: Dana Jewell, 454.4331; djj3260@bjc.org
TEAM TRANSPORT
Physician Leader: Sherrie Hauft, MD, 454.2589; hauft@kids.wustl.edu
Non-Physician Leader: Linda Behrens, 454.4450; lindab@bjc.org
TEAM 12 West
Physician Leaders
Jeff Leonard, MD, 454.2625; stephaak@bjc.org
Michael Noetzel, MD, 454.6120; noetzelm@neuro.wustl.edu
Non-Physician Leader: Steph Kroener, 454.4629; jleonard@wustl.edu
TEAM 9 West
Physician Leader: Robert Hayashi, MD, 454.6018; hayashi_r@kids.wustl.edu
Non-Physician Leader: Melissa Heigham, 454.6181; mkm8601@bjc.org
TEAM 8 West
Physician Leader: Sara Tycast, MD, tycast_s@wustl.edu
Non-Physician Leader: Lisa Coakley, lmc5261@bjc.org
TEAM 8 East
Physician Leader: F. Sessions Cole, MD (interim), 454.6148; cole@kids.wustl.edu
Non-Physician Leader: Michele Lane, 454.2553; michelmt@bjc.org
TEAM 7 West
Physician Leader: Mark Grady, MD, 454.6095; grady@kids.wustl.edu
Non-Physician Leader: Shelley Perulfi, 454.2652; srj0473@bjc.org
TEAM 7 East
Physician Leader: Albert Faro, MD, 454.2707; faro_a@kids.wustl.edu
Non-Physician Leader: Ann Borgmeyer, 454.2553; anneb@bjc.org
TEAM APC
Physician Leader: Jennifer Cole, MD, 454.6215; colejw@msnotes.wustl.edu
Non-Physician Leader: Staci Beck, 454.6161; stacilb@bjc.org
TEAM 10th Floor
Physician Leaders
Brad Warner, MD, 454.6066; brad.warner@wustl.edu OR
John McAllister, MD, 454.6215; mcallisj@notes.wustl.edu
Non –Physician Leaders
Cathy Madonna, cem7362@bjc.org
Franca Weitenberner (interim), 454.2843; faw1821@bjc.org
Randy Scott, 454.2497; rws13987@bjc.org
TEAM RADIOLOGY
Physician Leader: Robert McKinstry, MD, mckinstryb@mir.wustl.edu
Non-Physician Leader: Paula Vise, 454.6235; pcv3807@bjc.org
TEAM SDS/PACU
Physician Leaders
Dave Molter, MD, 454.2136; molterd@wustl.edu
Joan Niehoff, MD, 454.2615; niehoffj@wustl.edu
Douglas Coplen, MD (interim), 454.6034; coplend@wustl.edu
Non-Physician Leader: Jean Stroud, 454.4784; jean.stroud@bjc.org
TEAM ANSWER LINE
Physician Leader: Randy Sterkel, MD, sterkel_r@wustl.edu
Non-Physician Leader: Suzanne Wells, 362.5482; snw4713@bjc.org