A decade after the publication of the Institute of Medicine's report To Err is Human, healthcare in the United States continues to lead to unnecessary injuries and deaths. The majority of adverse events and medical errors are attributed to poor elements of teamwork and unnecessary variation in patient care practices. The goal of this project is to implement a family-centered safe practice infrastructure, including teamwork training (TeamSTEPPSTM) and Integrated Clinical Pathways (ICPs), to improve the quality and safety of care in a pediatric congenital heart disease service line (PCHSL). This patient population is a complex high-risk group that has wide variations in outcomes and their care occurs throughout a complex system of hospital units with a large number of multidisciplinary care teams. TeamSTEPPSTM is a teamwork training program for healthcare developed by the Department of Defense and the Agency for Healthcare Research and Quality. ICPs are patient care plans designed to improve quality by decreasing unnecessary variations in care and standardizing best practices for a specific patient population. Although isolated studies of these ICPs have shown significant improvements in patient outcomes and efficiency, the success of ICPs has been inconsistent. Poor implementation strategies, teamwork, and institutional support have been implicated in the failure of ICPs. The hypothesis is that incorporating a rigorous teamwork training program with project management, family advisors, and frontline staff input will provide a foundation for successful implementation of ICPs.
The specific aims of this project are: 1. Implement a robust communication and teamwork foundation for the general care of the inpatient PCHSL using a tailored TeamSTEPPSTM training program. 2. Design and implement ICPs for two of the most common congenital heart disease diagnoses using the specific teamwork tools of TeamSTEPPSTM and evidence-based standardized care throughout the entire hospital stay. Teamwork training will be completed for all healthcare personnel involved in the target patient population. Teamwork will be measured through a validated teamwork observation tool. ICPs will be designed and implemented utilizing program management, clinical experts, family advisors, and frontline staff participation. Expected improvements compared to a baseline pre-intervention period will be in outcome measures such as decreased hospital length of stay, days on ventilators, and readmission rates. There may also be improvements in quality measures in the non-ICP patients due to improved teamwork alone. The final product of this initiative will be a toolkit and dissemination plan for use in other patient populations.

Public Health Relevance

Infants and children with congenital heart disease require complex surgical procedures and inpatient care from a large team of multidisciplinary care providers. Multiple studies and reports have linked poor teamwork and variation in care practices to the majority of all unnecessary deaths and injuries in healthcare. The goal of this project is to implement a reproducible family-centered safe practice infrastructure including teamwork training and standardized care management plans (clinical pathways) to improve the quality and safety of care of hospitalized children with congenital heart disease.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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Hogan, Eileen
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University of North Carolina Chapel Hill
Schools of Medicine
Chapel Hill
United States
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