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1.
Pediatrics ; 140(3)2017 Sep.
Article in English | MEDLINE | ID: mdl-28814576

ABSTRACT

OBJECTIVES: To determine if an improvement collaborative of 33 children's hospitals focused on reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs). METHODS: A 3-year prospective cohort study design with a 12-month historical control population was completed by the Children's Hospitals' Solutions for Patient Safety collaborative. Identification and dissemination of best practices related to 9 HACs and SSE reduction focused on key process and culture of safety improvements. Individual hospital improvement teams leveraged the resources of a large, structured children's hospital collaborative using electronic, virtual, and in-person interactions. RESULTS: Thirty-three children's hospitals from across the United States volunteered to be part of the Children's Hospitals' Solutions for Patient Safety collaborative. Thirty-two met all the data submission eligibility requirements for the HAC improvement objective of this study, and 21 participated in the high-reliability culture work aimed at reducing SSEs. Significant harm reduction occurred in 8 of 9 common HACs (range 9%-71%; P < .005 for all). The mean monthly SSE rate decreased 32% (from 0.77 to 0.52; P < .001). The 12-month rolling average SSE rate decreased 50% (from 0.82 to 0.41; P < .001). CONCLUSIONS: Participation in a structured collaborative dedicated to implementing HAC-related best-practice prevention bundles and culture of safety interventions designed to increase the use of high-reliability organization practices resulted in significant HAC and SSE reductions. Structured collaboration and rapid sharing of evidence-based practices and tools are effective approaches to decreasing hospital-acquired harm.


Subject(s)
Hospitals, Pediatric/standards , Iatrogenic Disease/prevention & control , Medical Errors/prevention & control , Patient Safety , Quality Improvement , Cohort Studies , Cooperative Behavior , Humans , Prospective Studies , Reproducibility of Results , United States
2.
Pediatr Qual Saf ; 2(2): e013, 2017.
Article in English | MEDLINE | ID: mdl-30229152

ABSTRACT

BACKGROUND: Our objective was to describe changes in pressure injury (PI) rates in pediatric hospitals after implementation of an active surveillance and prevention bundle and to assess the impact of bundle elements. METHODS: The Children's Hospitals Solutions for Patient Safety (SPS) Network is a learning collaborative working together to eliminate harm to hospitalized children. SPS used a 3-pronged approach to prevent pressure injuries: (1) active surveillance, (2) implementing and measuring compliance with the prevention bundle, and (3) deploying a wound ostomy team. Among hospitals participating since 2011 (phase 1), we used negative binomial analyses to assess change in PI rates. Only phase 1 hospitals had a baseline period before any prevention bundle intervention. Among all hospitals participating in 2013 (phases 1 and 2), we used funnel charts to assess the association between reliable bundle implementation and PI rates. RESULTS: Among the 33 hospitals that participated in SPS from 2011 to 2013 (phase 1), the rate of stage 3 pressure injuries declined from 0.06 to 0.03 per 1,000 patient-days (P < 0.001). Stage 4 pressure injuries declined from 0.01 to 0.004 per 1,000 patient-days (P = 0.02). Among all 78 hospitals in phases 1 and 2, the cohort that adopted each bundle element, measured compliance, and achieved 80% prevention bundle compliance had significantly lower PI rates compared with all hospitals. CONCLUSIONS: SPS hospitals saw a significant reduction in stage 3 and 4 PIs over a 2-year period. Reliable implementation of each element of a prevention bundle was associated with lower PI rates.

3.
Pediatrics ; 136(5): e1353-60, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26438709

ABSTRACT

OBJECTIVE: Surgical site infections (SSIs) negatively affect patients and the health care system. National standards for SSI prevention do not exist in pediatric settings. We sought to reduce SSI-related harm by implementing a prevention bundle through the Solutions for Patient Safety (SPS) national hospital engagement network. METHODS: Our study period was January 2011 to December 2013. We formed a national workgroup of content and quality improvement experts. We focused on 3 procedure types at high risk for SSIs: cardiothoracic, neurosurgical shunt, and spinal fusion surgeries. We used the Model for Improvement methodology and the Centers for Disease Control and Prevention SSI definition. After literature review and consultation with experts, we distributed a recommended bundle among network partners. Institutions were permitted to adopt all or part of the bundle and reported local bundle adherence and SSI rates monthly. Our learning network used webinars, discussion boards, targeted leader messaging, and in-person learning sessions. RESULTS: Recommended bundle elements encompassed proper preoperative bathing, intraoperative skin antisepsis, and antibiotic delivery. Within 6 months, the network achieved 96.7% reliability among institutions reporting adherence data. A 21% reduction in SSI rate was reported across network hospitals, from a mean baseline rate of 2.5 SSIs per 100 procedures to a mean rate of 1.8 SSIs per 100 procedures. The reduced rate was sustained for 15 months. CONCLUSIONS: Adoption of a SSI prevention bundle with concomitant reliability measurement reduced the network SSI rate. Linking reliability measurement to standardization at an institutional level may lead to safer care.


Subject(s)
Patient Care Bundles , Patient Safety , Surgical Wound Infection/prevention & control , Child , Hospitals, Pediatric , Humans
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