Coming up through the ranks as a newborn intensive care nurse, Peggy Gordin, RN, MS, spent 25 years learning the best ways to support children in crisis and help pediatric patients get the highest quality of care. “I eventually became president of the National Association of Neonatal Nurses, but as I moved into a leadership position, I began to truly realize how much of an impact a nurse could have on the health care system and the care received by patients,” says Gordin, a 2011-2014 Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow.
Now chief nursing officer and vice president for patient care at the award-winning St. Louis Children’s Hospital, Gordin has taken her lessons and applied them to the everyday dilemmas health care professionals face when forming coalitions to improve care. Her focus is spurring interdisciplinary collaboration, while helping the hospital find resources to address patients’ mental, as well as physical, health concerns.
The Power of the Team
“Many hospitals have multidisciplinary teams, but I strive, along with my colleagues, to ensure that our teams are highly evolved in the way we work together,” Gordin says. “Our Unit-Based Joint Practice Team model is unique in the degree of structure and training we provide for team leaders. We also place a great emphasis on being sure that everyone on the team feels free to talk about patient needs. We work to create a hospital culture where people are not inhibited by hierarchies when it comes to doing what’s best for patients.”
Gordin and her colleagues concentrate on four key areas of care:
Stopping crises before they start: While being highly attuned to the needs of the sickest patients may seem like a natural role for hospital care providers, Gordin points out that “there is still a high mortality rate in the nation’s hospitals in cases where there is a ‘failure to rescue’ patients quickly when they begin to decline, which may lead to events such as cardiac arrest.”
To address this, Gordin and her colleagues implemented a Rapid Response Team (RRT) and scoring system to better identify patients at risk for deteriorating quickly. The score, called the Pediatric Early Warning System (PEWS) has been implemented in several other pediatric facilities and is now built into the electronic medical records at St. Louis Children’s Hospital, with significant customization to fit varied patient populations. The PEWS evaluates a patient’s behavior, cardiovascular system and respiratory effort.
“Our goal was to eliminate the possibility of any child having a respiratory or cardiac event outside of the Intensive Care Unit (ICU),” Gordin says. “The RRT resulted in decreasing mortality outside the ICUs from 0.09 deaths per 1,000 patient days pre-implementation to 0.03 deaths per 1,000 patient days [post-implementation] in 2011. The hope is that the recent addition of the PEWS score will eliminate all unexpected mortality outside the ICUs.”
Communicating for better care. As part of efforts to increase collaboration and improve patient safety, Gordin and her colleagues have strengthened team communications skills and handoffs. Using team communications techniques such as the Situation Background Assessment Recommendation (SBAR) and TeamSTEPPSR, a tool developed by the Agency for Healthcare Research and Quality, team members learned how to more effectively share information about patient progress and care. The St. Louis group is now part of a national study on improving resident handoff communications.
Including all key players. To further ensure that the care team understands the full range of patient needs, practice teams include parents of former or current patients. The hospital even uses parents as trainers in its simulation center to help staff members practice communicating under stressful situations.
“We have instituted a shared leadership model to make sure that care decisions include all disciplines,” Gordin says. “Councils composed of nurses and staff from all allied health care professions make decisions on patient care systems. All of the health care providers here—nurses, physicians, respiratory therapists, pharmacy and frontline staff—work as a team.”
“The goal is to make it possible for everyone on the staff to speak up on a patient’s behalf,” Gordin adds. “So many times, I’ve heard someone say, ‘I’m concerned about such and such, but I’m just a nurse.’ I tell that person, no one on this care team is ‘just’ anything; everyone has an equal right, responsibility and power to speak up and support our hospital’s motto, which is to ’do what’s right for kids.’”
Addressing mental health. In addition to guiding practice team progress, Gordin is working to help her staff meet patients’ mental health needs. “When I began my work here, I found that our staff was unprepared to work with patients who might have autism, bipolar disorder or other mental health issues. So we have provided training in de-escalation and behavior management techniques,” Gordin says. The effort includes partnerships with community-based organizations to give patients access to out-patient care. Gordin is leading the development of a strategic plan for child mental health services at the hospital—something that has become a focus due to her advocacy.
Reluctant to claim even partial credit for St. Louis Children’s Hospital’s presence on U.S. News & World Reports’ Honor Roll of Best Children’s Hospitals in the United States for 2012, Gordin says, “I am passionate about providing comprehensive, superior care for our patients, as well as enhancing safety, but every success here is the result of a team effort. My primary role is to remove obstacles, provide resources, make sure everyone feels respected and that each member of the team finds their voice.”