Diving into quality improvement and patient safety

As a University of Toronto resident specializing in paediatrics at North York General Hospital (NYGH), Dr. Kim Zhou always felt like North York General was her second home.

Dr. Zhou at her computer
Paediatrician Dr. Kim Zhou

“The hospital is a great place and while going through my residency here in different areas I was able to witness it. The staff and paediatricians are phenomenal, supportive and very welcoming.”

Improving practices

Dr. Zhou has now been a full-time paediatrician at the hospital for two years. Part of the reason she wanted to work at NYGH was because it's a community hospital where you can make a difference in the lives of patients and implement changes that will have a lasting impact. With this in mind, Dr. Zhou is making strides in quality improvement and patient safety initiatives.

“I was fortunate to have been mentored by a doctor who was deeply interested in quality improvement and patient safety,” says Dr. Zhou. “Quality and safety initiatives are opportunities to improve a routine practice already in place, trying new ways of doings things and implementing them throughout the hospital if they work well. Ultimately, the goal is to improve patient care.”

Quality and safety improvements like a backup parachute

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Dr. Zhou in a plane getting ready to skydive

After a recent trip to New Zealand where she went skydiving for the first time, Dr. Zhou came back with a great analogy. “Quality and safety improvements are like the backup parachute in your bag in case the first one doesn't work.” While the first parachute has gone through all the right steps to be released when in the air, there is always a chance it may not work. Having a backup plan can save your life, much like quality improvements in health care.

Dr. Zhou getting reading to skydive for the first time on a recent trip to New Zealand. “Quality and safety improvements are like the backup parachute in your bag in case the first one doesn't work.” Having a backup plan can save your life, much like quality improvements in health care. 

 

Improving critical congenital heart disease screening

Dr. Zhou has recently completed two quality improvement initiatives as the Newborn Quality Lead. The projects are 1) NYGH being a pilot site for the screening of critical congenital heart disease (CCHD) – a group of serious heart defects in newborns, and 2) car seat testing for babies going home.

“Screening for critical congenital heart disease is easy to do, cost effective and important to identify in the early stages as it can be fatal,” says Dr. Zhou. “We partnered with Newborn Screening Ontario and became a pilot site to screen all newborns prior to discharge.” 

The procedure is performed when the newborn is 24 to 48 hours of age and is done by checking the oxygen saturation levels through the hands and feet. A small rubber probe gently clamps the baby's finger or toe to get the reading needed to identify if the baby has signs of critical congenital heart disease. Screening babies before being discharged from hospital is important in order to start treatment early if a baby is identified.

Elimination of routine baby care seat testing

The second project is the elimination of routine baby car seat testing in preterm and small-for-gestational-age infants, in accordance with the Canadian Paediatric Society guidelines. 

Previously before leaving hospital, a baby would sit in a car seat for 90 minutes while being monitored by nursing staff. If certain criteria or monitor readings weren't met, it would mean a longer hospital stay and retesting after 24 hours. This would cause families to worry about their baby not being well and create undue stress.

Dr. Zhou skydiving
With her backup parachute, Dr. Zhou skydives in New Zealand.

After looking into studies on the testing's efficacy, and the recommendations of the Canadian Paediatric Society, NYGH updated its guidelines to provide a more up-to-date policy as well as a better, less stressful experience for families. 

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Evidence showed that having a baby die unexpectedly while in a car seat is very rare, but if it occurred it was often associated with undetected critical congenital heart disease that had not been detected. This new change goes hand-in-hand with the new CCHD testing that has been implemented at the hospital. 

“The idea of implementing these improvements is to make sure the care of our patients is more holistic and that we are providing the right care, at the right time in the right place,” says Dr. Zhou. “We should be creating the backup “parachute” to provide the safest care for our patients.

This article first appeared in the April 2017 issue of The Pulse.

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