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Women and Children's Hospital of Buffalo, the only pediatric facility in Western New York, has used an AHRQ-designed patient safety program to improve care for children with bronchiolitis. Hospital administrators say AHRQ's TeamSTEPPS^® program reduced average days in intensive care, days on a ventilator, and the use of paralytic medications.

Developed by ´óÏóAPPand the Department of Defense, TeamSTEPPS is an evidence-based system aimed at optimizing patient outcomes and promoting a culture of team-driven care.

"We were very pleased with the results when we started using TeamSTEPPS at the pediatric intensive care unit (PICU)," said James Hereth, M.D., critical care physician for the intensive care units at Women and Children's Hospital of Buffalo. The hospital is part of Kaleida Health, the largest health care provider in the region. "While studying bronchiolitic intubated patients under two years of age, we saw a decrease in the number of ventilator days and length of stay in the PICU with these patients."

"There was a four-day reduction in the number of ventilator days and a five-day reduction in the length of PICU stays. Even more significant was the decrease in the amount of paralytic medication used with patients requiring intubation," Dr. Hereth added. The number of paralytic days decreased from six to two during the study conducted between 2007 and 2010. The chart below shows this decrease as well as the decrease in number of ventilator days and the decreased length of stay in the PICU.

These improvements were attributed to establishing more formal communications between bedside nurses and pediatric critical care fellows and physician assistants. Dr. Hereth said the hospital created "shared mental models," which are phrases referenced frequently among staff to encourage safe clinical practices. The phrase "more paralytic agents cause longer hospital stays," for example, helped reduce excess paralytic usage.

Other TeamSTEPPS strategies to improve care in the PICU included conducting briefings and debriefings before and after intubation, extubation, and critical admissions.

In addition to using TeamSTEPPS to improve care for children with bronchiolitis, Women and Children's Hospital used AHRQ's Hospital Survey on Patient Safety Culture to assess staff perspectives on patient safety issues, medical errors, and event reporting. Survey results from 2009 and 2010 revealed improvements in the measures corresponding to "Teamwork Within Units," "Management Support for Patient Safety," and "Overall Perceptions of Patient Safety."

"These survey results are encouraging. They show that more progress can be achieved at the PICU and in the upcoming years," said Sandra McDougal, R.N., M.S.N., director of quality and patient safety at Women and Children's Hospital.