LAUSR

BACKGROUND Central line-associated bloodstream infections (CLABSI) are the most common device-associated infections in hospitalized children. Surveillance and prevention are standard in inpatient hospital settings, but comparable processes are less robust for ambulatory patients with central lines. Our institution lacked a unified and consistent process for surveillance and review of ambulatory CLABSI. Utilizing performance improvement (PI) methodologies, we sought to create a comprehensive and sustainable process for collecting CLABSI surveillance and event review data on complex patient populations across ambulatory disciplines. METHODS We assembled key stakeholders by identifying services with the majority of patients discharged with central lines and utilized the Six Sigma methodology of DMADV (Define, Measure, Analyze, Design, and Verify) to understand and improve current processes. We performed current state analysis of infection tracking and data collection through process-mapping and utilized fishbone diagrams to identify root causes of inefficacies. Following value analysis, the team developed a future state process map and utilized Failure Modes Effects Analysis to identify and mitigate potential risks to the process. RESULTS We identified variable CLABSI data collection methods between our stakeholder ambulatory divisions. Upon completion, our PI work resulted in one process that: 1) provides CLABSI surveillance for ambulatory divisions; 2) creates a singular data infrastructure for confirmed infections; 3) streamlines communication to all divisions and homecare providers involved in the?patient's ambulatory care; and 4) promotes responsive learning through a multidisciplinary event review that highlights potential risk factors and generates proactive infection prevention measures. CONCLUSIONS Utilizing PI methodology, we created a lean and standardized process to consistently track ambulatory CLABSI and support effective communication across divisions and providers. Next steps include optimization of the event review tool, integration with inpatient CLABSI PI efforts, and tests of change based on event review data that ultimately shift attention to patient safety in the ambulatory setting.