video thumb outcomes Dr. Phil Kibort, Chief Medical Officer & V.P. of Medical Affairs, explains how to evaluate outcomes and what tools and information Children's Hospital can offer. When you are making a decision about where to bring your child for care, you want all the information you can get. You want to know how good a hospital is at treating the specific condition your child is facing. You also want to know how a hospital ranks in terms of keeping your child safe and healthy during his or her stay. These measurements are referred to as “outcomes.”

This page lays out information to help you compare Children’s Hospitals and Clinics of Minnesota with similar hospitals locally and across the country. The categories here represent six “quality measures” outlined by the Institute of Medicine. These categories are seen as a good way to compare facilities.



Serving the needs of all children


equitable

"The moms were surprised to be able to share their experience to another mother in their native language."

Read Pat's full story »


Asthma Patients Well Controlled

% of patients with asthma considered well controlled 

outcomes star

Our
hospital

36

Jan-Mar

2013

45

Apr-Jun

2013

52

Jul-Sep

2013

31

Oct-Dec

2013

 outcomes table line
Goal

50.6

Jan-Mar

2013

50.6

Apr-Jun

2013

50.6

Jul-Sep

2013

50.6

Oct-Dec

2013

Evaluating this chart: Higher is better.

Asthma interferes with quality of life and can lead to life-threatening asthmatic crises. We seek to control asthma sufficiently well that it does not interfere with patients’ lifestyles. Well-controlled asthma requires:

1.  An Asthma Control Test score >20

2.  No more than a single ED visit or hospitalization for asthma in the last 12 months,

3.  An asthma action (control) plan in the medical record, this plan must document asthma medication doses and purposes, information on how to recognize and what to do during an asthma exacerbation and information on the patient’s asthma triggers.

We have seen progress over the past several years with an increasing number of our patients achieving “well-controlled asthma”.

What we are doing to improve: We have implemented quality improvement projects, frequent feedback to clinicians, an asthma registry and an Asthma Care Coordinator on each campus to improve asthma care fo rour patients. 

Data Source: Chart audits and Minnesota Community measurement (MNCM). 

Benchmark Data: MNCM (statewide benchmark)


Optimally Managed Diabetes

% of patients with diabetes considered optimally managed

outcomes star

Our
hospital

15

Jan-Mar

2013

16

Apr-Jun

2013

22

Jul-Sep

2013

11

Oct-Dec

2013

 outcomes table line
Goal

24.15

Jan-mar

2013

24.15

Apr-Jun

2013

24.15

Jul-Sep

2013

24.15

Oct-Dec

2013

Evaluating this chart: Higher is better.

Juvenile diabetes can interfere with lifestyle and lead to serious, life-threatening complications as children mature. Children’s treats more children with juvenile onset diabetes mellitus (Type 1) than any other facility in the region. We have seen improvement in the number of diabetic patients with optimal management. This is defined as receiving all of the recommended screening tests annually and having a hemoglobin A1c that is close to the normal range (<8%). hemoglobin A1c is a measure of how high the blood sugar is over time.

What we are doing to improve: We have improved medical record documentation, developed a checklist to assist clinical personnel in obtaining all needed screening tests, added social services and educator’s services to the Diabetes Clinic. The clinicians receive monthly feedback on their individual patients’ optimally managed status.

Data Source: Chart audits 

Benchmark Data: Not available, we compare our performance over time


5.2.1.0 Documentation

% of patients with 5.2.1.0 documentation

outcomes star

Our
hospital

90

Jan-Mar

2013

92

Apr-Jun

2013

95

Jul-Sep

2013

98

Oct-Dec

2013

 outcomes table line
Goal

95

Jan-Mar

2013

95

Apr-Jun

2013

95

Jul-Sep

2013

95

Oct-Dec

2013

Evaluating this chart: Higher is better.

According to the 2007-2008 National Health and Nutrition Examination Survey, nearly 17% of children ages 2 to 19 are obese and almost 32% are overweight or obese. Pediatricians can help to prevent an escalation of this problem by providing counseling to their patients. 5-2-1-0 refers to 5 servings of fruits and vegetables, < 2 hours of recreational screen time, >1 hour of physical activity, and 0 sugary drinks. By counseling patients and families about these recommendations, pediatricians can help to prevent obesity. This measures whether clinicians documented their counseling of families about 5-2-1-0.

What we are doing to improve: We encourage all clinicians to document within the electronic medical record a 5-2-1-0 plan on every patient. Clinics receive feedback on their performance monthy.

Data Source: Chart audits 

Benchmark Data: Not available for 2013, but will be available for 2014 through MNCM. 



Achieving the best possible outcomes


QualityofCare

"To this day I have incredibly fond memories of everyone who had worked to save my life when I was a child (not once but twice within a 10 day period of time)."

Read Wendy's full story »


Actual to Predicted Length of Stay Ratio

outcomes star

Our
hospital

1.01

Jan-Mar
2013

1.03

Apr-Jun
2013

1.03

Jul-Sep

2013

1.06

Oct-Dec

2013

 outcomes table line

44 other
children's
hospitals

1.11

Jan-Mar
2013

1.10

Apr-Jun
2013

1.08

Jul-Sep
2013

1.09

Oct-Dec

2013

Evaluating this chart: Lower is better.

Actual-to-Predicted Length of Stay

The length-of-stay ratio compares how long a patient stays in the hospital (actual), to how long the patient was predicted to stay, given the severity of their illness.  A ratio of < 1.0 means a patient's stay was shorter than we expected. Children's performs better than its peers on this outcome.

What we are doing to improve: We are working to improve the discharge process. Improved discharge planning is the focus of an ongoing quality improvement project.

Data source: Pediatric Health Information System database sponsored by Child Health Corporation of America (PHIS) database, sponsored by Children's Hospitals Association.

Benchmark data: Average of 44 other children's hospitals submitting data to PHIS. The ratio is greater than 1.0 for both Children's and the PHIS benchmark because the expected length of stay comes from a larger, national database that includes general hospitals who usually have lower acuity patients. 


Percent of patients who left the ED without being seen (by % of patients)

outcomes star

Our
hospital

1.57

Jan-Mar

2013

1.5

Apr-Jun

2013

1.09

Jul-Sep

2013

0.84

Oct-Dec

2013

 outcomes table line

39 other
children's
hospitals

2.05

Jan-Mar

2013

1.83

Apr-Jun

2013

1.07

Jul-Sep

2013

1.33

Oct-Dec

2013

Evaluating this chart: Lower is better.

Left Without Being Seen

Patients and their families sometimes leave the Emergency Department (ED) after they register, but before they are seen and treated by a physician. Leaving before complete evaluation and treatment is called “elopement”. Elopement usually occurs more often when the wait to see a physician is long or ED staff do not communicate effectively with patients and their families. Children’s rates typically are lower than the rates at other children’s hospitals. This measure helps us monitor how efficiently and effectively the ED is functioning.

Data source: Pediatric Health Information System database sponsored by Child Health Corporation of America (PHIS), which reports the comparative performance of 39 other children's hospitals.

Benchmark data: PHIS and our own prior performance data.


Mortality

Actual to Predicted Mortality Ratio

outcomes star

Our hospital

.62

Jan-Mar
2013

.57

Apr-Jun

2013

.69

Jul-Sep

2013

.77

Oct-Dec

2013

 outcomes table line

44 other
children's
hospitals

.76

Jan-Mar
2013

.74

Apr-Jun
2013

.74

Jul-Sep

2013

.71

Oct-Dec

2013

Evaluating this chart: Lower is better.

We never want to see a child die, but sometimes, their illness is simply too advanced to treat. We track how we are doing at saving lives through the "Mortality Ratio." This compares how many patients died at Children's, to how many we expected would die given how sick they were when they came to Children's. The good news is that fewer patients died at our hospital than we expected based on their illness. We do our best to deliver miracles.

What we are doing to improve: All deaths are reviewed for potential ways to improve survival.

Data Source: Pediatric Health Information System database sponsored by Child Health Corporation of America

Benchmark Data: Average of 44 other children's hospitals. The ratio for both Children's and other children's hospitals' is less than 1.0 because the expected number of deaths comes from a larger reference database that includes general hospitals.  


Readmission

Readmission by Specific Condition within 7 Days
(by % of patients) - 2014

outcomes star

Our hospital

2.0%

Asthma

2.4%

Bronchiolitis

8.3%

Gastroenteritis

11.1%

Sickle Cell Anemia
 outcomes table line

Goal: 10% reduction

1.8%

Asthma

2.2%

Bronchiolitis

7.5%

Gastroenteritis

10.0%

Sickle Cell Anemia

Evaluating this chart: Lower is better. 

Readmissions are a measure of quality of hospital care and how well the hospital arranges the transition from inpatient to home care. Children's has targeted 4 diagnoses for readmission reductions of 10% in 2014. These diagnoses are asthma, bronchiolitis, gastroenteritis, and sickle cell disease.

What we are doing to improve: Children's has implemented case management, which is working with clinicians to prepare patients for transfer to home care optimally. We have also joined a national collaborative, The Children's Hospital Solutions for Patient Safety, working together with over 30 other hospitals to reduce pediatric readmissions.

Data Source: Children's Data Warehouse

Benchmark Data: Internal


Minnesota State Reportable Adverse Health Events

0

GOAL per quarter

2

Jan-Mar

2013

1

Apr-Jun

2013

2

Jul-Sep

 2013

2

Oct-Dec

2013

Evaluating this chart: Lower is better.

Adverse Health Events

Adverse health events are rare medical complications that seriously affect patients and are usually preventable. All Minnesota hospitals are required to report these events to the Minnesota Department of Health. Included are patient falls with injury, severe pressure ulcers, wrong site/side/procedure surgeries, retained objects after surgery, and similar serious events. Our largest number of reportable events occur because of pressure ulcers.

What we are doing to improve: We are part of a national collaborative to reduce serious safety events through shared learning and analysis. We have also implemented multiple strategies to prevent pressure ulcers, such as frequent skin examinations of high-risk patients, and employment of serveral nurse practitioners to work with nursing untis to prevent, identify and treat pressure ulcers more effectively. 

Data source: Voluntary reporting and screening of patients.

Benchmark Data: Internal comparisons.


Medication Errors

Adverse Drug Events that Harmed a Patient

0

GOAL
per month

25

Jan-Mar
2013

11

Apr-Jun
2013

21

Jul-Sep

2013

 13

Oct-Dec

2013

Evaluating this chart: Lower is better.

Adverse drug events are mistakes in medication preparation or administration that put the patient at risk for and adverse event. We identify these events through voluntary reporting, electronic screening of the medical record and monitoring of the bar code medication administration system.

What are we doing to improve: We employ multiple strategies to reduce these potentially harmful occurrences: 

1. Pharmacists are assigned to clinical units to assist with medication reconciliation, acquire a complete and accurate medication history at admission and to oversee the prescription of and administration of medications.

2. We have implemented bar code medication administration throughout the hospital to ensure that medication administration is accurately recorded and in accordance with clinicians' orders.

3. We are educating Pharmacy staff on error prevention strategies, safety science, and crucial conversations to increase awareness of best practices for reducing dispensing errors.

4. Children's participates in a natinal collaborative of over 100 Children's hospitals that share best practices to reduce adverse drug events.

Data source: Internal data sources including bar code medication administration and Electronic Medical Records data and voluntary reporting.

Bencheckmark Data: We use internal comparisons. National benchmarks are not available.


Healthcare Associated Infections

Central Line Associated Bloodstream Infections

Central Line Associated Bloodstream Infections–Pediatric Intensive Care Unit
(per 1,000 Central Line Days)

1.4

National
Benchmark

0.6

Jan-Mer
2013

0.7

Apr-Jun
2013

0.7

Jul-Aug
2013

0.8

Sep-Dec
2013

Evaluating this chart: Lower is better.

Central Line Associated Bloodstream Infections- Neonatal Intensive Care Unit
(per 1,000 Central Line Days)

1.3

National
Benchmark

0.0

Jan-Mar
2013

0.0

Apr-Jun
2013

1.9

Jul-Sep
2013

0.0

Oct-Dec
2013

Evaluating this chart: Lower is better.

In hospitals, we use "intravenous lines" (IVs) to help give medications to sick patients. One type of IV is a "central line", which is a thin tube inserted into a large vein that goes ot the heart. Central lines can be very useful for taking care of some children. However, because the IV goes directly to the bloodstream, bacteria (germs) can also enter the bloodstream and cause infection if we don't follow standard procedures when using the line to give medicine. These infections are called "Central Line-Associated Bloodstream Infections" (CLABSIs).  

How we are improving: Nurses and doctors follow a standard "bundle" of methods when inserting the central line, and when caring for the line after it is inserted to make sure it is kept clean. They also wash their hands before they use an IV to give a medicine. Children's also participates in two national projects with other children's hospitals to share best practices to prevent these infections. Our ultimate goal is to have zero CLABSIs. 

Data source: Children's Infection Prevention and Control Surveillance Data.

Benchmark data source: Centers for Disease Control and Prevention National Healthcare Safety Network http://www.cdc.gov/nhsn/


Surgical Site Infection - Ventriculoperitoneal (VP) Shunt

Surgical Site Infection -
Ventriculoperitoneal (VP) Shunt

3.2

National
Benchmark

2.2

Oct-Dec

2012

5.5

Jan-Mar

2013

0.0

Apr-Jun

2013

3.9

Jul-Sep

2013

Evaluating this chart: Lower is better.

When a child has too much fluid inside the brain ("hydrocephalus"), a doctor can place a plastic tube (called a "Ventriculoperitoneal (VP) Shunt") in the center of the brain. This plastic tube goes under the skin and ends in the child's belly. The tube drains fluid from the brain into the abdomen. However, the plastic tube inside the body or the skin around the incision site can become infected. If an infection develops that appears to be related to the surgical procedure, it is classified as a "Surgical Site Infection" (SSI).

 How we are improving: We are using a standard "bundle" of methods to follow before and during the procedure. Children's is collaborating with other hospitals across the nation to share methods for how to reduce these infections. 

Data source: Children's Infection Prevention and Control Surveillance Data

Benchmark data source: Centers for Disease Control and Prevention National Healthcare Safety Network http://www.cdc.gov/nhsn/ Note: This is not a pediatric specific benchmark.



Honoring patient and family values


DSC 0659

"Children's became our 'home'. I can't say enough about the wonderful care she received while there and the incredible support we received as a family."

Read Emily's full story »


Overall Rating - Hospital

Overall rating of care (% top box response)

outcomes star

Our hospital

74

Jan-Mar

2013

80

Apr-Jun

2013

79

Jul-Sep

2013

78

Oct-Dec

2013

 outcomes table line

Other
childrens
hospitals

 80

Jan-Mar

2013

80 

Apr-Jun

2013

80 

Jul-Sep

2013

 80

Oct-Dec

2013

Evaluating this chart: Higher is better. 

Children’s Hospital strives to be the best pediatric hospital in Minnesota. We ask our families, after their visit with us, whether or not they would recommend our services to their friends and families. We track this measure as a 12-month rolling average.

What we are doing to improve: Our unit managers follow their scores and share them with staff. We constantly ask for feedback from our Family Advisory Council, which includes parents of Children's patients.

Data Source: NRC Picker Family Survey. We survey a 10% random sample of all patients each month.

Benchmark Data: Top 25% of participating children's hospitals based on the 4 most recent quarters.


Willing to Recommend - Hospital

Willingness to recommend (% top box response)

outcomes star

Our hospital

83

Jan-Mar

2013

85

Apr-Jun

2013

85

Jul-Sep

2013

87

Oct-Dec

2013

 outcomes table line

Other
childrens
hospitals

 80

Jan-Mar
2013

 80

Apr-Jun

2013

80 

Jul-Sep

2013

 80

Oct-Dec

2013

Evaluating this chart: Higher is better. 


You are a critical part of your child's care team, and doctors and nurses should partner with you in caring for your child. We want to know if you would have liked to be more involved in decisions about your child's care.   

How we are improving: Our unit managers follow their scores and share them with staff. We constantly ask for feedback from our Family Advisory Council, which includes parents of Children's patients.

Data Source: NRC Picker Family Survey

Benchmark Data: Top 25% of participating children's hospitals based on the 4 most recent quarters.



Overall Rating - Ambulatory

Overall rating of care (% top box response)

outcomes star

Our hospital

79

Jan-Mar

2013

81

Apr-Jun

2013

80

Jul-Sep

2013

80

Oct-Dec

2013

 outcomes table line

Other 
childrens 
hospitals

82 

Jan-Mar

2013

82 

Apr-Jun

2013

 82

Jul-Sep

2013

82 

Oct-Dec

2013

Evaluating this chart: Higher is better. 

Children’s Hospitals and Clinics of Minnesota, strives to provide the best care and service possible to our families and patients. Children’s has chosen as its measure of patient and family satisfaction with that care, only the highest score to the question, “Would you recommend this provider and his/her office to your friends and family?”.

What we are doing to improve: Clinicians and Clinic managers track their scores and share them will all staff. We constantly seek feedback from our Family Advisory Council, which includes parents of Children's patients, and our staff. We use this input to improve our clinic processes.

Data Source: NRC Picker Family Survey. We survey a 10% random sample of all patients each month.

Benchmark Data: Top 25% of participating children's hospitals based on the 4 most recent quarters.



Willing to Recommend - Ambulatory

Willingness to recommend (% top box response)

outcomes star

Our hospital

90

Jan-Mar

2013

92

Apr-Jun

2013

92

Jul-Sep

2013

90

Oct-Dec

2013

 outcomes table line

Other
childrens
hospitals

82 

Jan-Mar

2013

82 

Apr-Jun

2013

82 

Jul-Sep

2013

 82

Oct-Dec

2013

Evaluating this chart: Higher is better.

Children’s Hospitals and Clinics of Minnesota, strives to provide the best care and service possible to our families and patients. Children’s has chosen as its measure of patient and family satisfaction with that care, only the highest score to the question, “Would you recommend this provider and his/her office to your friends and family?”

What we are doing to improve: Clinicians and Clinic managers track their scores and share them will all staff. We constantly seek feedback from our Family Advisory Council, which includes parents of Children's patients, and our staff. We use this input to improve our clinic processes.

Data Source: NRC Picker Family Survey We survey a 10% random sample of all patients each month.

Benchmark Data: Top 25% of participating children's hospitals based on the 4 most recent quarters.