Taking on an ambitious program to standardize and improve medical care is no easy task. When your staff includes 12 surgeons, it might be viewed as pure folly. But James McCarthy, MD, MHCM, director of the Division of Orthopaedics, had no doubts his staff would get on board.

“Getting 12 surgeons to agree on anything isn’t easy,” he acknowledges. But McCarthy took the time to educate his team about the evidence behind specific quality improvements, and the benefits to patients and staff. “And I asked for their help,” he says, a step that was crucial to the program’s success. As a result, staff and faculty have not only embraced the changes, but are continually looking for new ways to make improvements.

Their projects have ranged from standardizing treatments of common fractures to reducing surgical site infections.

One of the earliest quality improvement projects rolled out in early 2011. The division developed a reliable system to monitor patients at risk of compartment syndrome, a rare but dangerous swelling that can occur after bone surgery. By putting in place a system of monitoring and early alerts, McCarthy says, “We eliminated undetected compartment syndrome. We can detect the problem early on and treat it as needed. It has had a dramatic effect because if it occurs in even one child, it can be devastating.”

Another project, begun within the last two years, implemented a “stacked breath” protocol for children with neuromuscular disorders who undergo spine surgery. Breath stacking is a technique to keep lungs clear of secretions. It is used for people whose breathing muscles are weak – common in children with neuromuscular disease. “By introducing this protocol, we’ve nearly eliminated post-op pneumonia, a common problem for these sicker kids – one that can delay their stay and even cause death,” says McCarthy.

Like many improvements the division has made, the protocol required partnering with the staff of other divisions, including Hospital Medicine, Pulmonary Medicine and Respiratory Therapy. Working with other hospital divisions is one of the many benefits of quality improvement work, McCarthy says. “There’s been great benefit in working with other divisions to accomplish our goals.”

Best of all, he adds, the changes have improved patients’ and families’ experiences. Children have better outcomes, their hospital stays are shorter and parents feel good about their care. Cincinnati Children’s is breaking new ground in its quality improvement efforts, says McCarthy, and he is delighted that the Division of Orthopaedics can play a role.

“Every major children’s hospital does this, but we have been doing it for a long time. You could say we are at the forefront of some of the quality improvement work.”