title: A multicenter collaborative approach to reducing pediatric codes outside the ICU.
abstract: OBJECTIVE
  The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points.
  
  
  METHODS
  A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores.
  
  
  RESULTS
  Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%.
  
  
  CONCLUSIONS
  A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.
authors.affiliation: Department of Pediatrics, Children’s Hospital of Alabama, University of Alabama, Birmingham, AL 35233, USA. lhayes@peds.uab.edu
authors.forename: Leslie W
authors.initials: LW
authors.lastname: Hayes
authors.forename: Emily L
authors.initials: EL
authors.lastname: Dobyns
authors.forename: Bruno
authors.initials: B
authors.lastname: DiGiovine
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Brown
authors.forename: Sharon
authors.initials: S
authors.lastname: Jacobson
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Randall
authors.forename: Beth
authors.initials: B
authors.lastname: Wathen
authors.forename: Heather
authors.initials: H
authors.lastname: Richard
authors.forename: Carolyn
authors.initials: C
authors.lastname: Schwab
authors.forename: Kathy D
authors.initials: KD
authors.lastname: Duncan
authors.forename: Jodi
authors.initials: J
authors.lastname: Thrasher
authors.forename: Tina R
authors.initials: TR
authors.lastname: Logsdon
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Barry
authors.initials: B
authors.lastname: Markovitz
mesh_terms: D016887:Cardiopulmonary Resuscitation; D002648:Child; D002654:Child Care / Q000458:organization & administration*; D046688:Child Mortality; D002675:Child, Preschool; D059019:Clinical Coding / Q000458:organization & administration*; D016001:Confidence Intervals; D003299:Cooperative Behavior; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation; D006307:Health Systems Agencies / Q000458:organization & administration; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D017751:Safety Management; D018709:Statistics, Nonparametric; D014481:United States