When infant and toddler nurse Megan Keydash met one of her future patients for the first time, he was sedated and asleep in The Charlotte R. Bloomberg Children’s Center’s pediatric intensive care unit (PICU). Born with his bladder outside his body, the 8-month-old baby had weathered hours of reconstructive surgery and was beginning a recovery that would last months.

Like other babies treated at The Johns Hopkins Hospital for the rare condition called bladder exstrophy, this young patient stayed in the PICU for several days before settling into the infant and toddler unit, where he would remain for six weeks with legs in traction to prevent motion, plus a couple more weeks to be weaned off sedation.

Moving children with such complex conditions to an acute care unit can be stressful for the nurses assuming responsibility for their care, says Dawn Luzetsky, assistant director of pediatric nursing.

Now, thanks to a nurse-led communications improvement initiative, nurses like Keydash are better prepared to receive these patients. Keydash met the baby and his family prior to the move, and discussed his care with PICU nurse Missy Wicklin. She even visited the PICU a second time to make sure the boy was ready for her unit, where there are three patients per nurse instead of the one-to-one ratio of intensive care.

The Building Bridges program was launched a year ago by Wicklin and fellow PICU nurse Kim Politz to improve communication between nurses in different units of the Children’s Center. The need became more pronounced after the new facility opened in 2012 and ushered in such procedure changes as PICU stays for bladder exstrophy babies who had previously gone directly to the acute care unit after surgery. “It helps to actually meet the patient and talk to the family,” says Keydash. Michelle Mowry, another infant and toddler nurse, agrees. “We get to know little tricks, such as what the children like and how we can console them.”

Encompassing the entire Children’s Center, Building Bridges brings together roughly 20 nurse leaders who share information about procedures in their units while increasing their own understanding of other areas. Although the group meets just four times a year, it is easing nurse frustration and inspiring improvements in patient transfer and reporting procedures, Wicklin says.

(Other Johns Hopkins hospitals also have mechanisms to improve communication across units. For example, Suburban Hospital has monthly nursing council meetings with representatives from every unit, and All Children’s Hospital has several communication improvement efforts that include nurses.)

At the first Building Bridges meeting, many nurses who had worked in the Children’s Center for decades encountered colleagues they had never met, highlighting the barriers that can exist between units. “When everyone is in their silos, it becomes difficult to put the patient in the center of what we are doing across the continuum of care,” says Luzetsky.

Infant and toddler nurses now share their knowledge of bladder exstrophy care with PICU nurses who have less experience with the condition. And unit nurses better understand the reasoning behind what they had previously seen as a frustrating duplication of reports, resulting from a change in procedure with the move to the Children’s Center.

Now, patients already in the hospital go first to a preoperative unit instead of directly to the operating room for surgery, explains Kim Sexton, a nurse in the pediatric preoperative and post-anesthesia care unit. This change means unit nurses must provide two reports before their patients go into surgery—one to the operating room team and one to the preoperative team.

The unit nurses didn’t understand why they were being asked to report twice on the same patient, until Sexton explained the procedure change at a Building Bridges meeting. Later, Sexton created an information sheet that explained the reason for the preoperative call, what questions to expect and what information to provide.

Building Bridges also has improved the procedure for alerting nurses when patients move from one unit to another, says Politz. Although a physician team still determines when a patient is ready to move, that decision is now relayed to the receiving nurse and the relinquishing nurse at the same time, instead of going first to the receiving nurse.

Similar group discussions aim to reduce the number of patient transfers that occur close to a shift change. If the discharging nurse gives a patient’s report to a receiving nurse who then passes it on to the nurse in the next shift, information can get lost, says Politz. It’s better, she says, for both the receiving and the discharging nurse to remain on the job for several hours after a patient transfer. 

Because of Building Bridges, Children’s Center nurses are now more comfortable asking each other for information or advice, says Wicklin. “I think every unit had the feeling that we were supposed to know what we were doing and we should not need help from anybody else. A big part of what we have achieved is that we now share our knowledge and ideas for how to fix things.”