BetterLiving Magazine - Carle Foundation Hospital's Guide to Good Health

Children's HealthChildren's Health

At the Fourfront of Care

When Tiffany and Jon Michaels of Bloomington learned last fall that they were to become parents of not one but four babies, they were overjoyed, excited and a little apprehensive. After weighing their options, the couple decided to have the babies at Carle Foundation Hospital.Tiffany came close to going into labor when the babies were just 24 weeks along, but a timely intervention allowed them to make it to 28 weeks (a key milestone, considered the threshold of fetal viability). The births went smoothly, with a dedicated team of doctors and nurses for each baby working swiftly and efficiently to stabilize all four newborns – the smallest of whom, Lauren, weighed just a pound and a half – before transporting them to the neonatal intensive care unit (NICU).

To many this might sound like a difficult and even harrowing experience, but Tiffany Michaels sees it differently: “People think – oh what a horrible experience, but in fact, it’s kind of weird to say, but we had a great experience!” Under the care of the NICU staff, her babies steadily grew over the following weeks, none of them falling victim to any of the complications or infections that can pose such danger to infants so young. This success is due, in part, to Carle’s membership in a unique organization.

Vermont Oxford Network - Hospitals collaborating on process improvements

For the past seven years Carle’s NICU has been part of the Vermont Oxford Network, a global network of NICUs all working together to improve the quality and safety of medical care for newborns and their families. There are now 700 hospitals in the network, 500 of them in the U.S., and participation continues to grow.

The network provides a structure for collaboration, allowing hospitals to conduct targeted process improvement studies in which they isolate one particular aspect of care for low birth weight newborns (such as infection reduction), and then pool their resources and their expertise to generate creative ways of improving that care.

This process can take several years, with local hospital teams conducting focused research projects and then sharing their results with other hospitals in their working group. This continues until the group is able to present a set of guidelines, based on their findings, which can be applied by all Vermont Oxford hospitals.

Carle Foundation Hospital’s specific areas of focus thus far have included infection, nutrition, breathing, blood pressure and the processes of daily care. In each area, major changes and minor adjustments have transformed the entire Carle NICU culture. Carle Clinic Association Neonatologist, William Stratton, MD says that in a way, the Michaels family represented a major test of everything that had been put in place since Carle joined the network. The focus, after all, has been on high-risk cases, “and it doesn’t get much more high risk than a set of 28-week-old quads.” Carey Gaede, a nurse practitioner who is closely involved in Vermont Oxford echoes this sentiment. “From the very low birth
weight admission process, to co-bedding our newborns, every process we’ve implemented through Vermont Oxford directly impacted the Michaels family.” Here are just some of the quality improvements Carle has put into practice as a result of participation in the Vermont Oxford Network:

  • Developing a first-hour care script for pre-term births, ensuring that all necessary steps are followed during the critical first hour of life.
  • Standardizing a written guideline for a consistent and safe transition from tube to oral feedings.
  • Promoting exclusive use of breast milk, maternal or donor, for the smallest and earliest babies (especially multiples) so that they receive the protective and nutritional benefits of breast milk.
  • Participating in a study to gain a more precise definition for chronic lung disease.
  • Enacting measures to dramatically reduce the occurrence of severe eye problems in the smallest infants.
  • Working towards a standardized treatment for low blood pressure.
  • Utilizing a “playbook” for consistent pain management during bedside procedures.
  • Focusing on improved communication with families by, for example, conducting daily bedside rounds as a team so that the parents can get all of their questions answered.

In addition to promoting ongoing improvements, Vermont Oxford also provides its member hospitals with access to a database containing vast amounts of data on very low birth weight babies. Member centers can use this pool of data in order to design projects and protocols related to outcome improvement. “The impact has been immeasurable,” says Dr. Stratton. “The Michaels reaped the benefit of six or seven years of pretty intensive process improvement.”
After spending months in the Carle’s NICU, all four Michaels babies – Reese, Gavin, Maggie and Lauren – are at home with their parents and, in Tiffany’s words, “doing great.” “I don’t want to do it again,” she laughs. “But if I had to do it again, I would put my babies in the exact same situation.”