Quality Improvement Interventions across a Network of Pediatric Hematology–Oncology Clinics

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Abstract
Achieving improvement in quality among different institutions is challenging. Immunocompromised children with febrile neutropenia are at high risk of severe infection. Pediatric hematology–oncology patients frequently experience central line–associated bloodstream infections (CLABSIs) associated with implanted catheters. A network of 8 pediatric hematology–oncology clinics affiliated with St. Jude Children’s Research Hospital launched 2 initiatives designed to reduce the incidence of infections and improve infection treatment. We reviewed the timing of antibiotic administration for immunocompromised patients with a fever before and after a quality improvement intervention tailored to each affiliate clinic. We also reviewed the frequency of CLABSIs before and after implementing a central line care bundle for implanted catheters in ambulatory patients. Across the affiliate clinic network, the timing of antibiotic administration improved from the preintervention period (23% of patients received antibiotics within 60 min of registration) to 53% and 73%, in successive postintervention periods. Implementing a central line bundle for implanted catheters was associated with increased compliance and a trend toward increased time between CLABSIs. We describe an approach to quality improvement utilizing a system of monitoring with annual clinical audits, development of joint quality improvement initiatives, ongoing education, and focused training of staff for effecting change that improves patient healthcare across multiple institutions.

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