A decade-long performance improvement project at Cincinnati Children’s has resulted in a 43 percent decrease in mortality rates in the pediatric intensive care unit (PICU) and a 34 percent decrease in hospital-wide mortality.
The decrease in mortality rates also has earned the 2012 RACE for Results performance improvement award from the national Children’s Hospital Association.
The RACE for Results award is given for exceptional clinical and business improvements in children’s hospitals. The Cincinnati Children’s project, “The Journey to High Reliability: Quality Transformation Leads to Improved Patient Outcomes,” was selected from more than 40 entries. A panel of hospital peers and international health care experts selected Cincinnati Children’s for impact and ability to replicate practices, so that peer hospitals can achieve the same results.
Cincinnati Children’s achieved success through aggressive efforts to reduce hospital-acquired infections, implement electronic health records, improved recognition of patient deterioration, prevent codes (emergency resuscitations) outside the PICU and mandate staff training throughout the hospital.
“The PICU is at the center of our hospital system and interacts with almost every other clinical service in the hospital,” says Derek Wheeler, MD, director of the PICU and associate patient safety officer at Cincinnati Children’s. “In addition, the vast majority of deaths in our hospital occur in the PICU. The PICU is our ‘canary in the coal mine.’ Improving processes of care in the hospital at large had a significant impact on the mortality rate in the PICU and throughout the hospital.”
As part of an overall initiative dating back many years to eliminate all serious harm at the hospital, Cincinnati Children’s embarked on a journey to become a high reliability organization. This is defined as an organization that avoids catastrophes despite existing in an unforgiving, highly complex environment where accidents occur. Examples of high reliability organizations include commercial and military aviation, the nuclear power industry and wilderness firefighting. Cincinnati Children’s adapted the lessons these industries learned to improve the safety and quality of care in the PICU and throughout the hospital.
In fiscal year 2001, the mortality rate in the PICU was 4.6 percent. Through multiple hospital-wide initiatives, the mortality rate dropped to 2.6 percent at the end of fiscal year 2011. During the same period, the hospital-wide standardized mortality ratio (actual mortality rate divided by the expected mortality) declined from 1.03 to .68.