Pediatric Call Center
Not Pictured:
Karen Beeman
Kelsey Blessing
Krystal Chesnutt
Bailey Clunis
Christen Davis
Amanda Degner
Brittani Edds
Clarisa Finizio
Susan Fisk
Jennifer Francis
Cynthia Garde
Barb Golz
Jessica Hanavan
Teresa Hegarty
Amanda Huner
Susan Jensen-Pasono
Jamie Karlberg
Julie Klingel
Liz Lindvall
Pam Malowney-Lengerich
Kelli Massaro
Joy Miccio
Beverlee Michelson
April Patzer
Ann Petersen-Smith
Jenifer Radford-Schow
Louise Ramirez
Rebecca Schlegel
Stacie Skuches
Pamela Tabor
Nicole Thede
Sara Tiede
Jessica Veeder
24 Yost
Sarah
STRUCTURAL EMPOWERMENT TRANSFORMATIONAL LEADERSHIP
Better Tech, Better Care Two Steps Ahead
with The Central Line
Detective
Traditionally, clinical decision-making in telephone triage has relied on non-visual communication.
Times have changed. Cell phone technology has drastically improved, and the healthcare
industry, Children’s Hospital Colorado nurses overwhelmingly say, needs to improve with it.
A survey of Pediatric Call Center nurses showed 94 percent thought technology would improve
care. In fact, caregivers and families were increasingly asking if they could send a picture of
their child’s medical condition to show the patient and symptoms more clearly. Due to privacy
regulations surrounding protected health information, however, nurses couldn’t accept images
sent by email or text.
They knew they needed to do better, and a team of Pediatric Call Center nurses initiated a project
to do just that. With the assistance of our triage software vendor and careful planning, the
team developed a process to exchange pictures and video with families and caregivers in a secure
environment. Then they had to implement it.
For the first four months of development two nurses streamlined the process and developed
training for other staff. During this time, the Pediatric Call Center leadership team worked with the
legal department to develop guidelines to address concerns from telephone triage nurses who
hadn’t previously worked with visual communication.
And by March 2018, two thirds of the telephone triage nurses were utilizing media files when
requested or when the nurse thought it would benefit the overall assessment process.
Not only has this process improved caller-nurse rapport, this team has also seen Emergency
Department referral rates drop from 20.4 percent to 15.9 percent. This additional avenue of
communication enhances care. With help from a dedicated team of pediatric nurses, the Pediatric
Call Center continues to strive to put new technologies to better and better use.
Pictured:
Top: Deanna Miller, Teresa Hsieh, Michelle Beringer, Kristina Junge, Maria Ferlic,
Ingrid Betts, Judy Laney, Teresa Baird, Julie Munder
Bottom: Val Aymami, Lori McLean, Dan Nicklas, Sara Nudd, Jaime Klein, Suzie Bivrell
In January 2018, three days after the placement of a central line,
the blood culture of a patient in the Pediatric Intensive Care
Unit came back with an unusual result: serratia marcescens, an
organism not often seen in the blood. It wasn’t long before more
cases were identified.
KELLY WEST, MS, RN, CIC
As a member of the epidemiology team, Kelly West, MS,
RN, CIC, was assigned to lead the investigation. She started
by sending blood isolates for DNA fingerprinting. Each case
came back identical. In March, West enlisted the Colorado
Department of Health and Environment (CDPHE). More isolates
came back identical. The patients had been treated at different
times in different settings, but the contamination was coming
from a common source.
Blood samples taken from the affected patients came back
identical to the Colorado samples — making it a national health
threat. The affected patients all had central lines.
West started looking at suspensions, ruling them out one by
one, until she’d narrowed it down to the same pre-filled saline
and heparin syringes.
Working off this theory, West worked with CDPHE, the Centers
for Disease Control and the Federal Drug Administration to
issue a national alert. An organization-wide internal recall of all
suspected pre-filled saline and heparin flushes went out.
But she didn’t stop there. She also worked alongside multiple
teams to help find acceptable replacement products and to
communicate to staff and the families affected as to what
was going on. All affected patients at Children’s Hospital
Colorado were successfully treated for their central line
associated infections.
The FDA contacted the manufacturer of the pre-filled saline
and heparin syringes, who issued a voluntary recall of the 998
lots of product, all produced at a single plant in the Midwest.
By June 1, 2018, a total of 25 confirmed cases across 10 states
had been identified by the CDC.
Without Kelly’s thorough investigation, expertise, and hard
work many more patients across the country could have been
affected. At Children’s Colorado, that’s what we call a good catch.
West reached out to colleagues across the country. Had any
other facilities seen any recent blood stream infections caused
by serratia marcescens? One facility had: three new cases, in
Tennessee, more than 1,000 miles away.
Population Health | 25