By Gemma Burgess and Shauna Langenberger
In January 2017 our then NICU/PICU manager envisioned the need to create a better experience for patients, families and our care teams when transferring patients from the NICU/PICU to our inpatient units at the Alberta Children’s Hospital (ACH). Lead by our Quality Improvement specialist, we learned that parents were feeling unprepared, nervous and fearful of what was to come, particularly for our NICU families. Uhmmm… we were selling it as this joyful event to our NICU families? It turns out that our clinical teams shared these same concerns about a need to improve the continuity of care and relieve stress for all. This prompted the founding of EFFECT: Excellence in Family Focused and Effective Care Transitions.
More than a ‘start and stop’ project our aim was to create a cultural shift in improving patient transfers at ACH recognizing these early health care encounters also shape trust and expectations for families in their future healthcare journey. To create immediate change, we hosted a Design SPRINT bringing together a diverse group of PICU/NICU and inpatient stakeholder. This further clarified the key issues and allowed us to prioritize which ones to address. Including families with this work helped us learn that as healthcare providers, we often defined ourselves as belonging to ‘this team or that team’ or by geographic locations like the NICU or an inpatient unit however families do not apply this same thinking. Families view us as all part of the same ‘system’ which mean when one of us fails, we all fail together.
What we have achieved is a new collective intention and the processes in place to support a smoother transition: Preparation, preparation and preparation. This starts with the NICU initiating early conversations with families about a likely transfer, days but possibly weeks before the event for our most complex patients. NICU nurses build the transfer care plan to support the inpatient unit: here is how you take care of the infant and their family. “Never dreamt that I should pass that [information] along until I started filling out the care plan” This helps achieve the continuity parent(s)/caregivers are looking for. “ I saw the nurse knew… I didn’t even have to tell her that she likes it.” (Parent comments).
Our goal is to have all our NICU families tour the inpatient unit before transfer so they know where they are going and can ask questions. To support the tour, we have created tools such as the ‘Parent Conversation Starter’ that reflects our sincerity in encouraging families to ask ANY questions and share experiences prior to transfer with the receiving unit: getting to know one another. “At first I was thinking, what’s the big deal? [Transfer from NICU] and, then we were transferred. Yeah, this is a big deal! I’m so thankful that I had the tour to prepare.” We’ve simplified our actual transfer steps for units and physicians: far fewer pages/calls and built stronger collaboration between physician teams. Physicians from both units now prefer a face to face transfer conversation and emphasize round attendance and multidisciplinary planning meetings for longer stay and our most complex patients. This full team approach allows for a much smoother transition for all involved: One patient, one team.
Through capturing the patient/family transfer journey with our family representatives and staff we further identified the need to improve ‘what’ and ‘how’ we communicate at the time of handover. “We didn’t realize the terms we were discussing were not common place language on the inpatient units and therefore more confusing than helpful”. This has spawned work with our site Safest Together team and has resulted in a goal to systematically implement the IPASS handover tool across the ACH. Formal parent(s) and staff evaluations are collected following the transfers with the results coming back to the EFFECT site committee as we strive to continuously improve.
Though some of our initial leaders and team members have transitioned, our team continues as other staff and physicians have stepped up to continue this work: to foster a culture that consistently facilitates safe, seamless, collaborative and co-ordinated transitions for patients and families during acute care transfers at the Alberta Children’s Hospital, Calgary, Alberta.
Nurtured in the NICU stories created by the Canadian Premature Babies Foundation to highlight the wonderful work of doctors, nurses, and parent volunteers in Canada’s NICUs. For more information or if you would like to share an initiative happening in your NICU, please send us an email at info@cpbf-fbpc.org