Tuesday, May 01, 2012
A decade-long performance improvement project at Cincinnati Children’s Hospital Medical Center 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 for Cincinnati Children’s the 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.
“We learned from a very early point in our journey to high reliability that engaging family members was crucial to our successes,” says Dr. Wheeler. “In most cases, family representatives were included as members of the improvement team, or improvement goals and design changes were discussed with family representatives following initial testing and before system-wide spread.”
The project not only resulted in decreased mortality but also in cost reduction. The initiative to reduce ventilator acquired pneumonias in the PICU reduced hospital costs by $2.3 million during fiscal years 2006 and 2007. In addition, improvement work to reduce central line associated blood stream infections reduced hospital costs by $1.3 million.
Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report’s 2011 Best Children’s Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties – a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children’s is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org