Patient safety measure identifies potentially life threatening heart conditions in newborns

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York Central Hospital is committed to patient safety. With its many routine tests and safety procedures, the hospital prides itself in providing the best and safest care possible to patients and families. Among the many safety measures that the hospital routinely takes, is pulse oximetry for all newborns alerting hospital staff and physicians to potentially life threatening heart conditions prior to discharge home.

In early 2007, Greg Beros, a Town Councillor for the Town of Richmond Hill took a tour of York Central Hospital’s new Family Birthing Centre. He recalls what he said to his wife Heather following the tour. “I told her it’s a beautiful centre, but we’ll never need it,” says Beros.

The Beros family already had a daughter, Hannah, now 10, and had accepted that they’d have no more children. So when Heather became pregnant again in 2008, the couple was thrilled. “This was our miracle child,” says Beros.

The couple had no way of knowing how prophetic that would be – or the pivotal role that York Central would play in saving their newborn’s life. “York Central Hospital saved my son’s life,” says the proud father. “He might have had surgery at another hospital, but it was York Central that caught that he needed the special attention in the first place.”

After a normal pregnancy and delivery, Jesse Beros was born at the hospital on October 30, 2008. The next day, shortly before discharge, a nurse gave him an oxygen saturation test (pulse oximetry), where a monitor is placed on the finger or toes to read the baby’s oxygen level. If the oxygen level is low, it alerts staff to the possibility of a cyanotic heart defect.

Cyanotic heart disease, a type of congenital defect, is relatively rare. Some children have it identified before birth by ultrasound – but some, like Jesse, do not. “Unfortunately, babies with undetected cyanotic heart disease appear to be perfectly healthy until one of their blood vessels closes. This usually happens between days 3-5 after birth, at which time most babies have been discharged home,” says Dr. Gerald Friedman, the hospital’s Chief, Department of Paediatrics. “Once the vessel closes, the baby becomes critically ill and is identified as a ‘blue baby’. These babies need to be identified promptly, ideally before discharge.”

Pulse oximetry for newborns who show no symptoms of a cardiac abnormality is a rarity among GTA hospitals. Fortunately for the Beros family, the test has been routine at York Central since late 2004. The hospital has administered the test almost 10,000 times, and has now caught heart defects with it twice – two cases that more than justify its use, according to Dr. David Gryn, Neonatologist. “It’s well above the standard of care – it’s excellent care, and babies like Jesse are exactly why we do it,” says Dr. Gryn.

As soon as Jesse was tested, “all the bells and whistles went off,” says Beros.  Jesse was stabilized by the neonatal team at York Central and within hours, was en route SickKids in Toronto.

The diagnosis – transposition of the great arteries. In this potentially fatal condition, the positions of the vessels that take blood away from the heart to the lungs and the body are switched. The aorta comes out of the right ventricle, while the pulmonary artery comes out of the left. This means that blood that already has oxygen flows to the lungs, while blood that needs oxygen flows around the body.

Jesse underwent open heart surgery at SickKids at eleven days of age, and spent three weeks there. Today, other than the large scar on his chest, you would never guess that he has ever had a health problem. “He’s a happy camper, lots of smiles, very easygoing,” says Beros.

The Beros family is full of praise for the staff at the Family Birthing Centre, and for York Central’s advances in caring for mothers-to-be, high-risk pregnancies, as well as healthy and ill newborns. That includes Dr. Gryn, who made the initial diagnosis of Jesse. His arrival in July 2008 helped to ensure a consistency of care in York Central’s Level II nursery (often referred to as a neonatal intensive care unit or NICU) states Leanne McCullough, Manager of the hospital’s Woman and Child Program.

“Most Level II nurseries don’t have full-time neonatologists,” says Dr. Gryn. “The reason I came to York Central is that I saw the potential here, and the need for expanded services.” About 10-15 per cent of births end up in the nursery, for a stay that lasts anywhere from a few hours to several weeks. As a Level II nursery, York Central offers a wide range of specialized services, including short term ventilation and nasogastric (through the nose) feeding. The expert care team includes paediatricians; NRP-certified nurses (neonatal resuscitation); anaesthesiologists; respiratory therapists; physiotherapists; occupational therapists; a nurse educator; pharmacists; dietitians; lactation consultant; and social workers.

Having a full-time neonatologist means that “We can take care of sicker babies than in the past,” says Dr. Gryn, “babies that would have had to be sent to downtown hospitals.” For pregnancies with a higher than average chance of complications, York Central was the first community hospital in Ontario with a full-time, on-site Maternal Fetal Medicine (MFM) service.

Risks can increase due to many factors – the mother’s age, previous problem pregnancies, pre-existing conditions or conditions that develop during pregnancy, multiple births, and fetal growth abnormalities. MFM services include a full-time perinatologist, a geneticist, 3D/4D ultrasound technology, and a pediatric cardiologist with expertise in fetal echocardiography.

York Central’s family birthing centre includes two operating suites and a recovery room when babies are delivered by caesarean section. There’s also a neonatal resuscitation room, with all of the equipment needed to provide essential care to babies who require extra help as soon as they’re born.

With a now thriving baby at home, Beros says “We’re blessed.” He thinks of what would have happened if York Central hadn’t administered the pulse oximetry test, and can imagine only two results. “If it was during the day, we would have noticed Jesse turning blue and rushed him to the hospital. But if we put him to bed and a vessel closed at night, he would likely have died in his sleep. In my mind,” says Beros, “York Central Hospital saved my son’s life.”

As part of its on-going efforts to continually improve the patient care experience the hospital is pleased to have been recognized recently as a Best Practice Spotlight Organization candidate by the Registered Nurses Association of Ontario (RNAO). The hospital has committed to implementing and evaluating 18 RNAO Best Practice Guidelines over the next three years. The hospital is currently adopting guidelines on wound care, stroke management, falls prevention, client-centred care, as well as asthma management for paediatric and adult populations to enhance further safety to our patients, staff and visitors.

The Hospital is also a proud participant in the Safer Healthcare Now! program which improves the safety of patient care across Canada by reducing avoidable harmful events through learning, sharing and implementing appropriate interventions.

To further enhance patient safety, the hospital also has an exciting research collaborative with York University. This partnership enables the hospital to compete for research funding opportunities, moving us to the forefront of the latest research in patient safety. Appointed research scientists support development and implementation of health science research studies at the University. Areas currently benefitting from this partnership include: infection control, cardiac rehab, and wound care.