CHA Collaborative Improvement on Paediatric Sepsis

New Collaborative to help improve recognition & response to children with severe sepsis

Children’s Healthcare Australasia (CHA) is delighted to confirm that it has established an improvement partnership with the NSW Clinical Excellence Commission (CEC) to jointly host a Breakthrough Collaborative with the aim of reducing avoidable harm to children from severe sepsis over the next 2 years.

Severe sepsis in children is relatively rare, making detection more difficult. In Australia, there were at least 2,500 children admitted with a primary diagnosis of sepsis to CHA member hospitals in 2015-16. These children’s care cost close to AUD$50 million.  Nineteen children have died from sepsis in Australia and New Zealand in the last year. Others survived with permanent injury or disability.

CHA is excited to join forces with the CEC to host this Collaborative. This unique partnership brings together experts in improvement science with paediatric clinicians and leaders who are passionate about improving outcomes for children & their families. It also recognises the significant leadership role the CEC has played in recent years in reducing harm to adult patients from severe sepsis, and maximises the potential for that expertise to benefit children across New South Wales, Australia and New Zealand.

The Paediatric Sepsis Collaborative will draw on the proven improvement methodologies of the US based Institute for Healthcare Improvement. It will provide participating teams with intensive support and coaching to reliably implement a bundle of evidence based practices aimed at reducing harm to children from severe sepsis.

Over coming months CHA & the CEC are convening an Expert Panel with medical and nursing experts to inform our next steps. The Panel will review the research evidence and identify the key evidence based strategies for reducing avoidable harm to children from severe sepsis. This will include consideration of similar work by other countries such as the UK and the US.

Following the Expert Panel deliberations, CHA and CEC will work in partnership with a small number of paediatric services to test the care bundle & associated measurement tool to ensure they are robust and workable in the context of Australian and New Zealand healthcare.

Support will be provided to enrolling teams to prepare for the first Learning Session, which is expected to be held early in 2018. Preparations will include forming the collaborative team, introductory webinars on the breakthrough collaborative methodology, analysis of baseline performance at each participating site, and completion of a number of pre-work exercises for sharing at the Learning Session. Two further face to face Learning Sessions will be held during 2018.

Following each Learning Session, teams implement small scale, rapid tests of change during applied Action Periods. Each team will be supported to undertake small scale improvements with the aim of identifying successful strategies quickly. Data on both care processes and outcomes for patients will be shared regularly, and discussions facilitated with peers to accelerate the capacity of all teams to reliably implement the bundle.

There are several elements to the IHI’s Collaborative methodology which help to ensure any improvements are sustained and spread within each participating organisation. Services will learn how to hold the gains and embed practices in a manner that will ensure lower rates of harms to children from severe sepsis well beyond the life of this project.
 
Invitations to enrol in this Collaborative are open to member and non member hospitals  across Australia and New Zealand. A good number of services have already indicated their interest in enrolling & begun preparing to participate. 

For further information, please download an invitation to enrol.

If you have any more questions please contact the Collaborative Coordinator on +61 2 6175 1900  or email collaborative@wcha.asn.au

 

Great consumer focused resources that are available to show in your waiting areas or on your Health TV

The Clinical Excellence Commission has developed a grat vidoe that assists families to understand more about Sepsis. You could load this to your hospitals patient waiting room as a resouces that builds consumer knowledge and understanding of sepsis in children - it is here

Resources developed internationally

CHA has been in ongoing contact with representatives from a number of countries who are also conducting collaboratives. In mid June the UK team released their age greduated paediatric sepsis bundle. This paediatric sepsis bundle is NICE compliant PDF icon uk_paed_sepsis_bundle_2017_v2.10.pdf

What is a Breakthrough Collaborative?

The project will draw upon the methodology for collaborative improvement developed over many years by the Institute for Healthcare Improvement (IHI) in the US, and successfully employed by hospitals in Scotland, England, and other places, to achieve sustained improvements in patient care.

The IHI describes a breakthrough collaborative as a process that typically involves multiple hospitals working together over a 12-18 month period to support the reliable application of existing knowledge about best practice to a problem of common interest to the group so as to improve patient care and outcomes.  Their methodology usually involves at least 3 face to face Learning Sessions spread over about a 12 month period, plus regular exchange of data and insights between these meetings as each hospital tests its own theories on how best to implement the changes needed to achieve and sustain improvement.

The key criteria to choose the topic for any collaborative are:

  • That the problem affects a significant number of patients or involves significant harm to patients
  • There is a gap between what we do and what the evidence tells us we should be doing
  • There are known, evidence based interventions or changes that, if consistently used, will improve outcomes for women
  • The processes and outcomes are able to be reliably measured
  • There is a business case to make investing in collaborative improvement worthwhile

The IHI is clear that a Breakthrough Collaborative is a resource intensive tool that is not well suited to all improvement problems.  Its strength as a methodology is that it focuses on spread and adaptation of existing knowledge about best practice care to multiple settings to accomplish a common aim – in our case reducing harm to children from severe sepsis  It is designed to achieve sustained improvement embedded in organisational culture and systems. Teams that participate report feeling buoyed by the momentum of regular peer & expert support to strive for and achieve improved outcomes for patients over the short and longer term.

What can we learn from peers overseas?

In the US and the UK, the collaborative quality improvement projects undertaken have used similar methodologies to achieve significant and sustainable results in improved patient safety for children and young people:

  • The NHS has produced a library of quality service improvement tools. The full library can be accessed here
  • ​There is an agreed aim(s) with a measurable outcome and timeline
  • ​Each participating children’s hospital/service aligns its organisational safety priorities with the agreed goals of the collaborative
  • ​Each hospital shares baseline data with the other hospitals against which improvement efforts can be evaluated
  • Participants regularly share information, ideas and resources with one another aimed at assisting all services to improve against their own baseline measure
  • ​Each hospital has the flexibility to identify and implement their own PDSA (Plan, Do, Study, Act) cycles using the IHI Model for Improvement

What happens now?

Invitations to enrol in this Collaborative are open to member and non member hospitals across Australia and New Zealand. A good number of services have already indicated their interest in enrolling & begun preparing to participate.

For further information, please download an invitation to enrol.

If you have any more questions please contact the Collaborative Coordinator on +61 2 6175 1900  or email via collaborative@wcha.asn.au