Information on our efforts to continually improve patient safety and service quality at Johns Hopkins All Children’s

At Johns Hopkins All Children’s, we provide services across the continuum of care. All of our departments and services are involved in quality improvement activities and our efforts to continuously improve our services. 

Through our quality improvement activities, we strive for the highest levels of patient safety, optimal quality in clinical interventions, and excellence in patient and family experience. When establishing goals, defining measurement and choosing interventions, we use the best available evidence-based practices and guidelines in our decision-making.

There are many ways to look at and measure quality. We use information from key areas to help families, health care providers and others learn about our quality improvement efforts at Johns Hopkins All Children’s.

Central Line-Associated Bloodstream Infections (CLABSI) Measures

 A central line is an IV that is placed into a patient’s large vein, usually in the neck, chest, arms or groin. A central line bloodstream infection (CLABSI) occurs when bacteria or other germs enter the patient’s central line and then enter into their bloodstream. Health care workers, patients and families can play an active role in CLABSI prevention. Most of these infections can be prevented with the correct insertion, cleaning and care practice of a central line.

Johns Hopkins All Children’s cares for children with many complex chronic conditions. Often these conditions require a central line to be inserted to draw blood, or to give critically ill patients fluids and medications more easily. The line can be left in place for several weeks or months if needed.

Sometimes, bacteria or other germs can enter the patient’s central line and enter their bloodstream. This can cause an infection. These infections are serious but can often be successfully treated. Johns Hopkins Medicine tracks many different infections, including patients who develop a CLABSI.

Health care workers help prevent CLABSIs in many ways, including following specific guidelines for careful and sterile central line insertions. These guidelines are evidence-based guidelines and recommend proper maintenance of central lines and removing central lines from patients as soon as they are no longer needed.

What is Johns Hopkins All Children’s doing to improve?

Providing the best and safest care to our patients is our top priority. Part of this work includes preventing infections in the hospital, including central line associated bloodstream infections.

Johns Hopkins All Children’s follows evidence-based guidelines and best practices with the goal of eliminating all CLABSIs. We use a specific central-line insertion checklist to ensure central lines are inserted as safely as possible. The checklist details each action that must be taken before, during, and after the insertion of a central line. We also use supply bundles and kits for central lines, so that staff have all of their materials and supplies easily accessible in one place.

Monitoring adherence to best practices for central-line maintenance is also an important part of CLABSI prevention. We monitor compliance with the central-line maintenance bundle, which includes the monitoring of dressings and tubing.

Johns Hopkins All Children’s staff are always reassessing and evaluating if a central line is still needed with the goal of removing the central line as soon as possible.

Hand Hygiene Measures

Good hand hygiene is the number one way to prevent the spread of germs. Hand hygiene means cleaning your hands by either washing them with soap and water or using hand sanitizing gel. Health care workers should wash their hands before and after caring for each patient. It is important for patients, families and visitors to also practice good hand hygiene.

 At Johns Hopkins All Children’s, some employees are trained to watch how well medical staff keep their hands clean. They observe doctors, nurses and other health care workers to see if they wash their hands or use antibacterial gel before entering or leaving a patient’s room.

Johns Hopkins All Children’s takes hand hygiene very seriously. We monitor hand hygiene among hospital staff, and this information is shared with hospital staff and leadership regularly. The information is used to help to continually improve hand hygiene in our health system so that we can provide the safest and best care to all our patients.

Health care workers come into contact with patients, equipment and other items in patient rooms. In the hospital, there are many opportunities for hand hygiene to help keep our patients safe. The Centers for Disease Control and Prevention (CDC) says washing hands is one of the most effective ways to prevent the spread of diseases and infections. Ensuring doctors, nurses and other staff have clean hands is critical to preventing the spread of illness.

The Joint Commission, a health care accreditation organization, says direct observation of staff hand hygiene is the most effective and accurate way to measure hand hygiene compliance.

 

What is Johns Hopkins All Children’s doing to improve?

We strive for 100% hand hygiene compliance for all health care workers. Regardless of job role, every Johns Hopkins All Children’s employee must practice good hand hygiene to protect our patients, visitors, colleagues and friends.

• Posters and signs are placed around the hospital as reminders for health care workers, patients and visitors to wash their hands or use sanitizing gel. Staff and patients are also encouraged to speak up if they notice someone forgot to wash their hands.
• We also educate staff that may not have direct patient contact but still play a vital role in infection prevention through good hand hygiene.
• We recognize units consistently practicing good hand hygiene at committees and other forums. Our hand hygiene observers provide in-the-moment coaching when a staff member is observed forgetting to perform appropriate hand hygiene.

Surgical Site Infections Measures

At our children's hospital, we are dedicated to reducing surgical site infections (SSIs) through a comprehensive, evidence-based approach. We ensure that everyone involved in surgery is following the best practices.

We follow established prevention bundles, or checklists, that include proper preoperative skin cleaning, giving the right antibiotics at the right time, and ensuring that antibiotics are re-dosed when needed. We also maintain normal body temperature during surgery to help prevent infections. In addition to preoperative education about wound care, we reinforce proper postoperative care while the patient is still in the hospital.

We regularly analyze data across the hospital to spot trends and share our findings with key teams to improve our efforts. Performing the SSI prevention bundle allows us to track our progress and provide feedback for continuous improvement.

To further support our staff and patients, we offer continuous educational opportunities and optimize our discharge wound care instructions in Spanish and English to ensure families are well-prepared for at-home care. These actions, along with ongoing evaluations, help us maintain the highest standards for patient safety and recovery.

Patient Experience Measures 

We strive to create a safe, positive experience for our patients and families by respecting family preferences, needs, culture and values. These elements comprise our care delivery model that focuses on the following:

• Dignity and respect
• Information sharing
• Participation
• Collaboration
• Communication

Our families consistently provide us with feedback through a survey that measures the quality of hospital experiences. The Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey helps us assess and enhance the quality of care and service that we provide.

Emergency Center Measures

Left Without Being Seen is a performance measure of the percent of patients who left the Emergency Center before a medical screening has been initiated. Patients who presented to the Emergency Center are those who signed in to be evaluated for emergency services. This measure is an indicator of patient satisfaction and quality for emergency departments.

External Quality Reports

Please visit these websites for independent quality reports on Johns Hopkins All Children's Hospital: 

• The Joint Commission Find Accredited Organizations: Johns Hopkins All Children's Hospital
• FloridaHealthFinder.gov, a service of the Agency for Health Care Administration
• Leapfrog Ratings
• U.S. News and World Report Best Hospitals Rankings & Ratings

Contact us

We are here to make a difference in the lives of the patients and families we serve, and we value your feedback. Please let us know what we can do to improve by sending us a message through the Contact Us page.