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Where stewardship meets safety

Dr. Olivia Ostrow is a leading voice in Canada on quality improvement (QI) related to stewardship and safety for children. Despite the challenges faced as a clinician working the frontlines in a pediatric emergency room over the last 18 months, the QI work Ostrow is currently involved in has actually expanded during the pandemic. She’s joked that due to the increased virtual nature of some of her work, she can be presenting to people in Ontario one minute and then in Texas the next. But it’s this cross-border work that has her most excited, as someone who was born in the United States and spent a large part of her early career practicing there.

Here is just a snapshot of what Ostrow, staff physician and patient safety lead for the Division of Pediatric Emergency Medicine at the Hospital for Sick Children (SickKids) and the associate director for SickKids at CQuIPS, has on the go.

American Academy of Pediatrics
SickKids is just one of two Canadian sites (Ostrow also encouraged BC Children’s Hospital to join) in the American Academy of Pediatrics Value in Inpatient Pediatrics (VIP) QI collaborative that aims to reduce overutilization and unnecessary care in hospitalized children. Ostrow is currently a member of an expert working group on a utilization initiative related to bronchiolitis, a common disease in young children during the winter viral season. Because SickKids is also actively participating in the study, Ostrow is coaching her site as well as others in the United States on QI methodology and concepts. In November, she was a featured presenter on QI topics for all 90 participating hospitals. “It’s been a rewarding opportunity to be part of a North American QI collaborative and share some of my expertise,” she said.

Choosing Wisely
Ostrow is the associate director for SickKids’ Choosing Wisely program, and, nationally, the pediatric lead for the Using Antibiotics Wisely Campaign with Choosing Wisely Canada. Now, she’s turning her attention to supporting the creation of a list for pediatric emergency medicine, which will likely be Choosing Wisely’s first cross-border list for children. Part of the challenge for Ostrow and the team of pediatric emergency physicians in the US she’s working with is trying to narrow down recommendations to just five, and avoid overlap with other existing society lists. “It’s going to take several months, but we’re very excited,” she said. “It’s been a valuable learning experience and opportunity to collaborate with colleagues south of the border who are passionate about this work. By joining forces, we hope to create a bigger impact for children.” 

Community of practice
Together with Dr. Jeremy Friedman, associate paediatrician-in-chief at SickKids and the director of SickKids’ Choosing Wisely program, Ostrow has also helped establish a Canadian-wide community of practice to engage clinicians who are interested in resource stewardship for pediatrics. The group meets a few times a year to share stewardship opportunities, network and collaborate. “Our community includes almost all of the provinces – we’re getting there,” she said.

Pediatric emergency medicine
Ostrow was asked this fall to present at SickKids’ Pediatric Emergency Medicine Conference on safety issues she’s seen trend over the last year, partially through her roles as a medical safety leader at SickKids and as co-chair of the provincial Emergency Department Return Visit Program. She discussed opportunities to leverage systems to make it easier to flag abnormalities to healthcare providers such as abnormal vital signs which are very different in children than adults. At SickKids, there’s a built-in electronic double check for clinicians at discharge – any child with abnormal vital signs or who has not had vital signs checked within four hours is flagged as a last opportunity for clinicians in a busy emergency room to pause and confirm the child is safe to be sent home.

In her talk, Ostrow also focused on critical response time in addressing children who have swallowed button batteries. She is part of a multidisciplinary working group at SickKids working to help equip SickKids and other hospitals across the GTA to prepare for this problem as it only takes two hours for these batteries to permanently harm a child. Her talk also acknowledged the current risks with many hospitals experiencing staffing shortages in addition to high patient volumes. “As a safety leader, I wanted to emphasize our strengths, which are our colleagues, our system-level interventions and safety culture so that safety continues to be prioritized during these challenging times,” she said.

A passion for stewardship and safety
Ostrow’s work is in two distinct fields – stewardship and safety – that she says are far more connected than some may realize.

“While one might say that most over-testing and treatments doesn’t cause harm – maybe just a hassle –unintended consequences do occur, but are less often thought of and often more challenging to measure. For example, every time a child is referred for an unnecessary MRI or to see a specialist that doesn’t really need it, not only does that lead to time away from work and other challenges for families, but another child who really needs that care is potentially bumped and having to wait that much longer,” she said. “And how we treat children in healthcare now impacts the rest of their lives. For instance, if children receive antibiotics unnecessarily now, it makes them more prone to developing antimicrobial resistance, a current top global health threat.”

Ostrow has several upcoming talks on building safety cultures and QI. She will also be leading a CQUIPS+ QI primer on PDSA cycles in April.

“I consider myself a hands-on improvement specialist and my heart lies in solving frontline problems in healthcare,” she said. “I feel fortunate to have the opportunities to do that.”

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