Here’s an important example of how setting a clinical goal, then monitoring progress toward that goal can lead to significant improvements in clinical outcomes. The nonprofit National Association of Children’s Hospitals and Related Institutions (NACHRI) is leading an ambitious 3-year project that aims to eradicate bloodstream infections, the most severe infections threat in pediatric ICUs.
In April, NACHRI reported that, in the first six months of the three-year project, 29 hospitals participating in the project had collectively slashed infection rates by nearly 70%. How? By simply adhering to a rigid set of measures known to prevent infection in children. These measures included more rigorous care of catheters, higher sterile precautions, and constant assessment of the need for keeping catheters in place.
A review of published literature in the Journal of Pediatric Critical Care concluded that as many as 16% of children in pediatric units suffer from infections and these infections increase the risk of death by up to 20%. Studies also show that treating infection can add nearly $40,000 in additional hospital costs to a child’s stay.
Laboratorians will not be surprised to learn that the steps for preventing infections were fairly routine, but were difficult to get hospital staff to accept. Doctors and nurses alike were set in their ways and were resistant to protocols that lengthened the amount of time they had to spend on procedures. Among the NACHRI improvements to care targeting pediatric catheter treatment were: 1) to bundle of the insertion of catheters; 2) to make frequent dressing changes and provide extra skin cleansing with powerful antiseptics; and, 3) to constantly monitor whether a catheter needed to stay in place. Insertion protocol required that the child’s entire body be covered by drapes to provide a sterile environment and that gowns, gloves, and masks needed to be worn by catheter inserters.
Hospital Staff at the Children’s Medical Center of Dayton, Ohio were “exasperated” by the strict new guidelines, but after participating in the CHCA pilot, the hospital quickly dropped infection rates to zero and went 580 days without a bloodstream infection! Children’s Healthcare of Atlanta raised strengthened commitment to the program by posting “days since last bloodstream infection” prominently in staff areas. During the first 6 months of 2006, their rate of infections dropped to 1.2 per 1,000 catheter days, from 6.2 infections in the year before the initiative was started.
This case study shows that using quality management methods to accurately measure outcomes can indeed improve performance, particularly when all employees are committed to measuring and improving quality. Furthermore, phenomenal improvements over the status quo can be gained by gathering accurate data in real-time and managing to it. Adherence to protocols can indeed maximize patient safety.
Laboratory Directors and pathologists should take inspiration from this case study. Labs already face many of the challenges in motivating employees to change behavior to achieve improvements in outcomes. Quality management methods, including Lean and Six Sigma are powerful and effective ways to help staff accept improvement goals and adhere to quality standards. As the results of the first six months of the NACHRI program demonstrate, it is possible to quickly overcome longstanding clinical habits and achieve zero rates of bloodstream infections in Pediatric ICUs. Not only is that a major success for the participating children’s hospitals, but it is also a success for the families of children who avoid serious infections that are often caused by carelessness or inattention by their care team.