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Abstract
Background Racial disparities in healthcare outcomes are widely noted and seen in pediatric harm. The Solutions for Patient Safety (SPS) Patient Harm and Relation to Equity (PHARE) cohort was developed to assess racial and ethnic disparities for Central Line Bloodstream Infections (CLABSI) from a learning network approach. Cincinnati Children’s joined the PHARE cohort to identify CLABSI equity improvement opportunities.
Objectives Identify and close CLABSI disparities via data conversations, SMART Aims, and improvement methods.
Methods We analyzed 18 months of baseline data for PHARE submission using descriptive methodology (figure 1). Funnel charts determined statistical significance between group rates (figure 2). Following the initial analysis, data were presented to multiple organizational groups to build theories and increase engagement for a core improvement team. Team membership included front line staff, quality improvement experts, clinical leaders, and patients’ families. A key driver diagram was developed using input from data sharing, and interventions were identified. Ongoing work includes testing interventions using PDSA ramps and monitoring the data using control chart methods and rolling averages.
Results Initial data was presented to fifteen groups; resulting discussions were analyzed into themes (figure 3). After key driver development (figure 4), current interventions include adding equity questions to CLABSI event reviews and randomizing patients receiving bedside coaching. Ongoing analysis indicates that system special cause may impact some groups more than others. However, more data is needed to make any statistical conclusions. Current rolling average rates (figure 5) indicate we may be closing gaps, but it is too early for determinations.
Conclusions & Implications Sharing equity data showing gaps early and having honest conversations about root causes was key to richer system understanding, allowing more informed interventions. Increased buy-in from these early conversations decreased barriers to implementing interventions. A variety of displays has proven important in communicating data to various audiences.
Example of descriptive baseline data analysis: distribution of patient days, line days and CLABSI events. *Includes American Indian and Alaska Native; Asian; Multi-racial, Non-Hispanic; and Native Hawaiian and Other Pacific Islander
Funnel chart of CLABSI rate per 1000 line days (U-chart) to ascertain statistical significance
Pareto chart of qualitative presentation feedback to CLABSI rates disparities
Key driver diagram developed based on feedback
Small multiple CLABSI 12 month rolling average rate by race group
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