The quality revolution

How sharing information is reforming health care at the bedside

Carole Bartoo
Published: June, 2010

Health care reform is not a legislative invention. It’s a quiet revolution that is occurring in hospitals and clinics throughout the country. 

 
Carla Saunders, NNP, helped implement
changes that lowered the infection rate
in the NICU at East Tennessee
Children’s Hospital in Knoxville.
Photo by Joe Howell

Two years ago, for example, the staff at East Tennessee Children’s Hospital in Knoxville rallied around a project to prevent infections that can occur through central lines (catheters) inserted into babies’ tiny blood vessels.

Since 2008, they have cut the infection rate by 80 percent.

“We no longer accept infection as the cost of doing business,” says Carla Saunders, NNP, advanced care coordinator for the Pediatrix Medical Group at the hospital and a 20-year veteran neonatal nurse practitioner.

Thanks to the Tennessee Initiative for Perinatal Quality Care (TIPQC), the lessons learned at East Tennessee Children’s are now available to all of the other neonatal intensive care units (NICUs) in the state.

“No matter what a great job we do at our own hospitals, it won’t move the statistics a lot. We need to share what we do with others, and we need to learn from each other,” says Judy Aschner, M.D., the Julia Carell Stadler Professor of Pediatrics and director of the Mildred Stahlman Division of Neonatology at Vanderbilt University Medical Center. 

TIPQC was Aschner’s brainchild. Other states, like California, Ohio and North Carolina already had neonatal/perinatal care collaboratives. She went to the Governors Office of Children’s Care Coordination (GOCCC) and the March of Dimes to find funds to start one in Tennessee.

The collaborative officially got off the ground in late 2008. Peter Grubb, M.D., assistant professor of Pediatrics at Vanderbilt and the initiative’s medical director, said the goal for TIPQC is simple. Take the energy and initiative exhibited by people like Saunders, use it to devise evidence-based practices that can improve care, and then selflessly share with everyone.

"The air transportation industry adopted a non-competitive approach to flight safety some time ago,” Grubb explains. “Not sharing to gain a competitive advantage has become unthinkable. This ideal resonates with many stakeholders across the healthcare spectrum, and organizations like TIPQC provide a previously missing venue to share data and experience about patient safety and quality."

Saunders says it’s about time. “We have been good at sharing results of research for some time, but we have not been good at sharing quality improvement information. Maybe the lack of sharing was competition or fear based,” she says. 

After only one year of operation, TIPQC has more than 1,000 individual members, including nurses and physicians from groups representing all 27 NICUs in Tennessee, plus a growing number of Obstetrics/Gynecology practices.

Why reinvent the wheel

And it’s not just turning away from business-type competition. Within TIPQC, there is a palpable lack of credit-taking as well. Grubb and Aschner acknowledge Vanderbilt was instrumental in the launch of the collaborative model, but emphasize that TIPQC members are absolute equals in sharing insights, leadership and bright ideas. 

 
Judy Aschner, M.D.
Photo by Daniel Dubois

The East Tennessee group, for example, adapted a successful program promoted by the California Perinatal Quality Care Commission to prevent the spread of infectious agents through central lines. “Why re-invent the wheel?” asks Saunders.

Saunders boiled down the California approach and created a simplified toolkit. Earlier this year, 12 other NICUs began their own projects using East Tennessee Children’s toolkit and guidance. Their goal: to reduce central line infection rates in NICUs by 50 percent within the first year. 

This trend away from the business-model culture of competition and toward a culture of sharing and transparency is well timed. According to a December 2009 report by the state health department, Tennessee’s central line infection rates in both adults and children in 2008 exceeded the national averages.

The report noted that actions as simple as careful hand washing can greatly reduce the risk for infection, yet evidence-based plans to implement such precautions have been frustratingly difficult to implement across all hospitals.

Saunders hopes TIPQC’s program, based on coordinated sharing of quality improvement programs, will be the first to succeed in a big way.

“It is exciting because we should be learning from each others mistakes and successes,” Saunders says. “Some people might not have the staff and people to do what we did with the California plan, so we break it down and help them along the way.”

“The time is right,” adds Grubb. “We have had multiple opportunities to do the right things in the past and failed to take them. But the culture is changing. Now we’re taking those opportunities.”

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