Quality Transformation Network Reaches a Milestone

September 2011

Saving Lives, Saving Money

Children's hospitals across the country are celebrating a milestone in their quest to eradicate catheter-associated blood stream infections (CLABSIs) among hospitalized pediatric patients. After five years of quality improvement in pediatric intensive care and hematology/oncology units, children's hospitals in the National Association of Children's Hospitals and Related Institutions (NACHRI) Quality Transformation Network are estimated to have saved 355 lives, prevented 2,964 central line infections and passed $103 million in cost savings. 

How We Got Here

Being part of the Quality Transformation Network (QTN) requires members to follow rigorous tracking and measurement protocols. Once they join the program, each participating site provides 2-3 years of pre-QTN baseline data in order to create a basis for calculations of infections prevented. Lives saved are then estimated based on a published pediatric CLABSI infection mortality rate of 12%. Published costs for pediatric CLABSIs are in the range of $25,000 - $45,000 per infection, so the QTN estimates cost savings by multiplying the number of infections prevented by $35,000.

QTN collaborators set out early on to test infection prevention approaches that address day to day care of the central line (line maintenance). Central line infections in vulnerable pediatric patients exact a higher toll in morbidity and mortality than in adult patients, yet techniques that yield big reductions in infection rates in adults - practices related to inserting the line - are not as effective in children. "The QTN's success in preventing infections has been possible because of their pioneering work in techniques for daily care of central lines," explains NACHRI Quality Transformation Vice President Marlene Miller, MD, MSc. "Our program has demonstrated that line maintenance is essential for preventing central line infections in the pediatric population."

Working Together - Changing Culture

The Quality Transformation Network (QTN) engenders a culture of teamwork that transcends the institutional level. Sharing data derived from exacting measurement and tracking requirements was new for many members. The programs involve central line insertion and maintenance bundles and include rigorous methodology, tightly coordinated implementation, and large rich data sets gathered from monthly reports measuring process compliance and outcomes. Every unit's data is reported to all collaborative participants.

The QTN overcame initial skepticism that a focus on reducing line infections would lead to significant results. Collaborative team members have dedicated themselves to changing this perspective within the pediatric healthcare community. Learn more about how participation has changed the way clinicians view patient care practices in Anita Blumenthal's article, Quality: The Stories Behind the Stats.

Lawrence McAndrews, president and CEO of NACHRI notes, "The QTN has put a value on transparency among participating institutions that has not been seen in other programs. Recognizing that when it comes to patient safety there is no competition, QTN teams focus on improving clinical practices to provide an increased level of care."

An Ongoing Effort

In addition to the two programs already in place, a third collaborative was launched in 2011 for dialysis centers, focusing on peritoneal and exit site infections for peritoneal dialysis patients. The QTN anticipates continued success reducing infections, saving lives, and generating health care cost savings.

For additional information regarding the NACHRI Quality Transformation Network, please see these resources:

  • Reduction of PICU Central Line-Associated Bloodstream Infections: 3-Year Results, Miller M, Niedner M, Huskins C, et al. Pediatrics, in press.
  • Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts. Miller M, Griswold M, Harris JM, et al. Pediatrics 2010; 125: 206-213.