The Division of Neonatology at MUSC Children’s Hospital has a history of dedication to quality and safety, and the integration of evidence into clinical practice. We are proud to have a division that merges scientific methodologies with the assessment of quality and safety and evidence-based medicine. The integration of information gained from multiple core conferences, interdisciplinary collaboration and application of research techniques to quality improvement enhances the ability for greater medical decision making and overall patient and family care.
An integrated Quality and Safety program based on Evidence-Based Medicine:
We benefit from an academic environment in which new and emerging approaches to medical care are available and in which there is an emphasis on continuous assessment of clinical outcomes as those approaches are integrated into practice. With systems of communication in place to disseminate information to staff nurses and clinicians, a comfort with the scientific method of data collection and analysis, and a multidisciplinary team approach to quality and safety, we have developed a robust system in which our staff expect to discuss approaches to patient care that require critical review.
Our approach to Quality, Safety and Evidence-Based Medicine permeates not only our clinical care but also clinical and educational conferences. The Quality and Safety Case Conference (Q’n’S) serves as a forum at which presentations and discussions will occur that support atmospheres of team development and practice assessment/improvement. The goals of this conference are to review care offered to patients in the nursery system and identify opportunities for improvement – either through analysis of processes that might be improved or through the analysis and expansion of processes that went well. Our Q’n’S meeting works in conjunction with our multidisciplinary practice management conference used to design and implement practice protocols in neonatal medicine. The goal of this meeting is to improve clinical care through the application of evidence or best practices to patient care. The third leg of this process is the analysis of evidence using a standardized approach to Journal Club.
Medical Simulation Training:
Practicing quality care is augmented through the use of medical simulations. The state-of-the-art simulation center at MUSC offers staff the opportunity to develop the skills to effectively use this exciting and very useful educational tool. The simulation project arose from a quality analysis of clinical performance, expanded into a response to changes in resident and fellow education and the educational needs of NICU staff, and incorporated a clearly defined process and outcome measures that will allow us to scientifically analyze effectiveness of this tool in education and clinical outcomes. Our teams participate in simulations of the first two hours of postnatal life (our Golden Hours Project) addressing the stabilization of sick newborns and initiation of therapies in a timely and standardized manner. The Golden Hours Simulation initially developed as a multidisciplinary tool by fellows, nurse practitioners, and faculty, but has grown into an important part of our training of NICU and Obstetrical Delivery Room clinical teams. Simulation mannequins have also provided practice for perfecting procedural techniques in the neonate. Our use of simulations emphasizes our integration of the application of scientific principles to quality and safety and the integration of quality and safety in education.