Collaboration, organization and changes of processes can positively affect how patients receive care. These are the top three entries for the delivery system transformation category in the 2017 Pediatric Quality Award.
Learn how these three hospitals achieved more effective patient care. Each hospital was recognized in the 2017 Pediatric Quality Award for making positive improvements, from reducing serious safety events to improving care for children in the foster system.
Zero Serious Safety Events: Award-Winning Transformation at Yale New Haven Children's Hospital
Serious safety events (SSE) are a break from standard protocol that lead to serious harm or death. For Yale New Haven Children's Hospital in New Haven, Connecticut, its lackluster system for reporting SSEs made them difficult to track and prevent. After experiencing 15 SSEs in one year, the team set a goal to reduce SSEs to less than two per year and improve overall safety in the hospital.
Over the course of four years, the project team executed on several initiatives:
- Encouraged staff to increase SSE reporting to improve data collection, a step that was critical for future success. This allowed the quality and safety team to detect patterns and intervene with simulations in high-risk areas, such as the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU) and the emergency department (ED).
- Introduced a morning safety report that was attended by all unit leaders, medical directors, ancillary staff leaders and was opened to frontline staff every morning. Here, the group discussed all SSEs that occurred in the last 24 hours, potential safety concerns in the upcoming 24 hours, scheduled follow-ups for previously reported SSEs and recognized individual interventions that prevented a safety event.
- Identified and trained safety coaches in the frontline staff to be advocates for safety in their units. Some staff were also trained in common cause analysis to help identify the true cause of a safety event and fix any gaps in the process.
At the time of their project entry in 2017, Yale New Haven had gone 526 days without a SSE, saving the hospital nearly $3 million per year. SSE reporting increased by 852 percent.
Transforming Ambulatory CLABSI Education, Awareness and Prevention across an Organization and Beyond
Reducing inpatient central line-associated bloodstream infections (CLABSI) has long been a focus of Children's Hospital & Medical Center in Omaha, Nebraska. However, after being part of Children's Hospital Association's (CHA) Childhood Cancer and Blood Disorders Network (CCBDN)–a collaborative of CHA member hospitals working to reduce ambulatory CLABSIs in pediatric cancer patients–Children's Hospital & Medical Center discovered its hematology/oncology CLABSI rate was 18 per year. This brought a new focus to ambulatory CLABSIs among this population.
The project kickoff was in January 2016, targeting a reduction in CLABSI events by 50 percent within 12 months. Using Six Sigma Define, Measure, Analyze, Improve and Control methodology, the team implemented several organizational changes:
- Included staff in CLABSI meetings and the CCBDN collaborative. The team found this helped staff feel more invested in the work, and helped many start completing CCBDN forms because they understood the importance.
- Introduced a Hematology/Oncology Patient and Family Educator position to better prepare families to care for the child's central line prior to discharge. This also introduced more consistency in training.
- Created a staff survey for any employee who dealt with a patient's central line within seven days of an infection. The goal was to identify details that could be potential causes for CLABSI but may not be found in a chart review. This could include a home health nurse listing the presence of animals in the home that can impact cleanliness and the potential for CLABSIs.
- Surveyed patients and caregivers through interviews within one week post-CLABSI. This allowed caregivers and staff to have a conversation and pinpoint patient details that caused a CLABSI. Family surveys helped staff identify that one patient was picking at his port site, causing it to bleed and scab. Several days later, he developed an infection.
Children's Hospital & Medical Center's interventions led to more than a 50 percent reduction in ambulatory CLABSI events. In 2015, prior to the project, 18 events occurred in one year. In 2016, the team decreased events to eight. The hospital experienced a reduction in cost as well; a single CLABSI is estimated to cost upwards of $37,000. The project saved at least $370,000 in a single year.
Improving the Care of Children in Foster Care: An Academic-Community QI Collaborative
With varying guidelines provided by the American Academy of Pediatrics (AAP) and state and federal governments that define the well-being of children in foster care, it can be difficult to implement recommendations in pediatric practices. Duke Children's Hospital & Health Center in Durham, North Carolina, developed an academic-community QI collaborative to "impact the quality, effectiveness and efficiency of patient care by improving access to and timing of initial medical care for children entering foster care in [the] county."
In 2016, the goal was to reduce the time it took for an initial foster care evaluation at the Duke Foster Care Clinic from 32 days to seven days. The team also added an additional follow-up medical evaluation at the clinic that was not previously standard procedure for foster kids.
The development of the collaborative formalized how the team worked together to bridge the gap between the clinic and social services. To accomplish their goal, the team:
- Ensured appointments were available for foster care patients within 72 hours of being referred to the clinic. A backup plan was determined for the scheduler if appointments were not available within this timeframe, including a process for creating additional appointment times.
- Educated clinic staff on new guidelines in the clinic. Child Welfare program managers and social workers were also invited to join workshops that improved awareness of new recommendations to cut referral time.
- Modified evaluation forms to make them easier to use, while also identifying challenges and failures in real time.
By November, Duke Children's reached its goal. The success is credited to reducing the time it takes for social services to refer each child to the clinic, and scheduling patients sooner.