Cleveland Clinic Children's Outcomes

To avoid central line-associated bloodstream infections (CLABSIs), healthcare providers must follow a strict protocol when inserting the line in addition to following stringent infection control practices each time they check the line or change the dressing.¹ A Non-MBI CLABSI refers to a CLABSI that is not due to a mucosal barrier injury. This distinction is important in hematology/oncology, where many patients are at risk for mucosal breakdown.

At Cleveland Clinic Children's, there were no infections after March 2018, when the Visual Management Board checklist tool and other processes were initiated by a nurse-led CLABSI prevention team. In 2019, there were ZERO CLABSIs on the Pediatric Hematology and Oncology Unit. This significant achievement was the result of years of quality improvement measures, and a culture of safety and high reliability².

¹ Centers for Disease Control and Prevention. Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers. www.cdc.gov/hai/bsi/clabsi-resources.html. Updated Apr 1, 2010. Accessed Mar 19, 2018.

²Cleveland Clinic. (2019). Zero CLABSIs on pediatric hematology and oncology unit in 2019. https://consultqd.clevelandclinic.org/zero-clabsis-on-pediatric-hematology-and-oncology-unit-in-2019/

Readmission reduction is challenging because of patient population complexities and adverse effects of treatment. The Core 4 Elements for Safe Transitions promotes a reliable discharge process, which has been shown to reduce readmissions throughout Cleveland Clinic. Ensuring compliance with admission and discharge medication reconciliation, scheduling clinically appropriate follow-up appointments, and completing the discharge summary prior to discharge are associated with decreased readmission rates. There is a direct correlation between Core 4 bundle compliance and readmission rates. As compliance increases, readmission rates decrease. The Core 4 bundle is also associated with reduced costs and is a strong marker for safe patient care transition.

Fever and neutropenia are expected complications in children receiving chemotherapy for cancer. Management guidelines have been developed specifically for this pediatric population. Outcomes are dependent on timely intervention, especially time to antibiotic (ATB) delivery. A recent study of the pediatric hematology and oncology population at a large university practice during a 15-month period found that antibiotics were delivered within 59 minutes of outpatient check-in to all patients with cancer presenting with fever and neutropenia; the reported median time to ATB delivery was 43 minutes.¹ By adopting national guidelines for patients with fever and neutropenia, Cleveland Clinic Children’s aims to improve outcomes by administering ATBs within 60 minutes of a patient’s arrival on the hospital floor or in an outpatient clinic.

In 2019, a total of 92% of inpatients and 91% of outpatients with fever and presumed neutropenia received antibiotics within 60 minutes of arriving.

¹Salstrom JL, Coughlin RL, Pool K, Bojan M, Mediavilla C, Schwent W, Rannie M, Law D, Finnerty M, Hilden J. Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 minutes have decreased intensive care needs. Pediatr Blood Cancer. 2015 May;62(5):807-815.

After infancy, cancer is the leading cause of death by disease among US children. The Cleveland Clinic Children's hematology and oncology program works to reduce the time to treatment: the time period between cancer diagnosis and the initiation of treatment.

According to the latest US News and World Report scorecard, Cleveland Clinic Children's five-year cancer survival rates are above average nationally.