How to Launch a Multi-Year, Multi-Site Quality Improvement Collaborative

How to Launch a Multi-Year, Multi-Site Quality Improvement Collaborative

A sepsis collaborative standardized measurement, built effective teams, and shared findings across 66 member hospitals and health systems — reducing mortality by half.
Child in hospital bed, caregiver holding hand.

A multi-year, multi-site effort to decrease sepsis-associated mortality harnessed the power of collaboration among children’s hospitals to transform care and share lessons learned.

The work of the Improving Pediatric Sepsis Outcomes (IPSO) collaborative saved at least 570 children’s lives and reduced the 30-day sepsis-attributable mortality by nearly 50% among critically ill children.

“There was a paucity of information, evidence, and best practices published in the literature at the time we started this initiative,” said Charles G. Macias, MD, MPH, chief quality officer and division chief of pediatric emergency medicine at University Hospitals Rainbow Babies & Childrens, who co-chaired the collaborative. “It became critically important that we shared what was working and what was not working.”

The collaborative’s work

Launched in 2016, the IPSO collaborative brought together 66 children’s hospitals and health systems to improve outcomes for children with sepsis. Using multimodal quality improvement (QI) methodologies, evidence-based care bundles, and data-driven performance evaluation, the collaborative decreased not only mortality rates but also hospital days and antibiotic use among children with sepsis.

The collaborative categorized sepsis three ways: sepsis, sepsis critical, and suspected sepsis. Each member hospital focused on patients in four acute care settings:

  • Emergency departments.
  • Medical-surgical units.
  • Pediatric intensive care units.
  • Hematology-oncology units.

Functional workgroups within each hospital implemented evidence-based care bundles and tracked data using a centralized data portal. Sepsis care bundles included key processes, including:

  • Formal sepsis recognition through a sepsis screening, huddle, or order set.
  • Timely fluid administration (less than 30 minutes from recognition to first bolus).
  • Timely antibiotic administration (between 60 and 180 minutes from recognition to administration, depending on patient acuity).

Care bundle impact

By complying with the key processes outlined in the care bundle, the 30-day sepsis attributable mortality rate decreased by 47.7% among sepsis critical patients and by 80.5% among patients with suspected sepsis.

“Over the last 15 years, there's not been a magic bullet that has led to better sepsis outcomes. There's not been a new pharmacologic intervention. The literature around improvements in mortality and morbidity have come from improvement science and safety science, and this framework added a huge body of literature to the sepsis work,” Macias said.

Other notable results from the IPSO collaborative included:

  • 10-16% decrease in hospital days per sepsis episode.
  • 5-14% decrease in antibiotic days.
  • 7% decrease in ICU days.

The IPSO collaborative’s dataset contains more than 100,000 sepsis episodes, including 12,851 episodes of severe sepsis and 24,518 episodes of suspected sepsis.

“That is the power of large volumes of data. They show the relationship between bundle compliance and the outcomes. These were very powerful outcomes from the 66 hospitals engaged in this work,” he said.

Keys to successful large-scale QI work

Macias said coordinating the work among dozens of hospitals required forethought. Collaborative hospitals had different front-line processes and varied quality improvement priorities. Standardizing measurements and building effective teams at each site was key.

“Any pediatric hospital has a million priorities that makes it challenging to pick one over another. Being able to train teams to understand the value proposition was critical,” he said.

To solve for these variables, the IPSO team:

  • Developed a sustainable data pipeline.
  • Used quality improvement methodologies to identify and address gaps.
  • Right-sized teams based on the group’s collective successes and failures.
  • Shared findings among all collaborative hospitals.
  • Identified financial incentives and regulatory requirements related to sepsis.
  • Aligned the work with individual hospital goals.

Moving the work forward

The IPSO collaborative’s work was presented at clinically focused conferences and featured in journals such as Pediatrics and Critical Care Medicine. Collaborative leaders have also shared the IPSO care bundle with myriad pediatric providers and institutions, including pre-hospital settings, critical access hospitals, and children’s hospitals that did not participate in the collaborative.

Now that the IPSO collaborative’s formal work is over, Macias said it’s vital to continue to share learnings and track data to improve patient outcomes over the long-term.

To that end, Children’s Hospital Association is facilitating a Sepsis Community of Practice and supporting children’s hospitals’ sepsis data tracking and benchmarking needs through the Pediatric Health Information Systems (PHIS)® and Inpatient Essentials (IE) programs.

The Community of Practice offers tools such as webinars, an online discussion forum, and a library of resources; data collection allows for ongoing trending and benchmarking of key success metrics. The Community of Practice is open to any CHA member while data tracking is limited to hospitals that participate in PHIS and IE.

“We feel this approach hits upon all cylinders because it’s pushing safe, effective, patient-centered care,” Macias said.

This article is based on the “Improving Pediatric Sepsis Outcomes in the QI Collaborative” presentation at CHA’s 2024 Transforming Quality Conference.

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