Riley Children’s Health reached a tipping point in 2022.
The hospital experienced a rise in hospital-acquired conditions, but staffing challenges stymied efforts to increase rounding on patients with central lines, catheters, or risk of pressure injuries.
To address the issue, the quality and safety and nursing practice teams sought a solution that would enable staff to focus on patients with the highest risk.
Using data the hospital already tracked, the teams created a predictive dashboard to identify patients most likely to develop a hospital-acquired condition. It also identified opportunities to reduce lines overall.
“The data also allowed for more in-depth discussions in a multidisciplinary fashion among physicians, nurses, and managers about how to mitigate risk and to think differently about the way we care for patients,” said Stefan Malin, MD, MS, a pediatric intensivist at Riley Children’s.
The dashboard predicts the risk of central line associated bloodstream infections (CLABSIs), hospital-acquired pressure injuries (HAPIs), and catheter-associated urinary tract infections (CAUTIs) based on documented risk factors, said Mackenzie Fahey, MS, senior data analyst at Riley Children’s.
To arrive at a risk score, the dashboard stratifies items tracked in the EMR, such as:
- Chlorhexidine gluconate (CHG) baths.
- Dressing and linen changes.
- Number of times the line is accessed to give medicine or draw blood.
- Patient nutrition, mobility, and sensory perception.
- Patient language.
- Braden-QD scores.
- Neutropenia.
- Total number of devices connected to a patient.
“We made sure those things were being documented well so we could reconfigure the information in a way that gives us a risk score,” Fahey said. The dashboard shows the risk for each type of harm event as well as a patient’s overall risk based on the combination of three risk scores. Using the dashboard information, staff can focus on patients at highest risk for a hospital-acquired condition.
The outcome
The dashboard helped drive focused care to the bedside and ultimately reduced the number of hospital-acquired conditions and number of lines utilized.
- 35% reduction in CLABSI rate.
- 56% reduction in HAPI rate.
- 7.5% reduction in line utilization rate.
Reducing the risk
Quality and safety leaders on each unit review the report and disseminate information to the appropriate leaders. Wound, ostomy, and continence nurses look for ways to mitigate pressure injuries among patients while clinical nurse specialists seek to protect central lines or talk with the patient’s care team about removing the line. Physicians look at the big picture and help facilitate decisions regarding risk reduction.
Removing unused or unnecessary lines is one way the team reduces the chances of infections.
“Central lines are sometimes left in so we don’t have to disrupt patient care, but that may not be the best decision for the patient. The dashboard highlights those patients for more robust discussion among team members,” Malin said.
Harm timeouts
When a hospital-acquired condition does occur, the team convenes a “Harm Timeout” to discuss how to prevent the injury from happening again. A template captures information that might otherwise go undocumented, such as line complications or if the patient traveled off the unit.
“This has allowed us to look at recurring themes differently,” Malin said. “If we see pressure injuries among patients who have chronic malnutrition, how can we identify that as an additional risk factor to pull into the dashboard? Patients in the ICU who've had weight loss from critical illness will be at more risk, but that may not be captured in our current scoring algorithms. Our discussions provide a great deal of feedback into how we're using the risk report.”
This article is based on the “Creating a Predictive Dashboard for Hospital-Acquired Conditions” presentation at CHA’s 2024 Transforming Quality Conference.
