In 2006, the Board of Directors of the California Children's Hospital Association sponsored a collaborative quality improvement project with the California Children Services (CCS) program. The project began in September 2006 under the leadership of Paul Kurtin, M.D., Chief Quality and Safety Officer at Rady Children's Hospital - San Diego.

Project participants include all eight of the private, non-profit Children's Hospitals 1) Children's Hospital Central California; 2) Children's Hospital of Orange County; 3) Childrens Hospital Los Angeles; 4) Children's Hospital & Research Center at Oakland ; 5) Loma Linda University Children's Hospital; 6) Miller Children's Hospital; 7) Lucile Packard Children's Hospital at Stanford; 8) Rady Children's Hospital - San Diego as well as UCLA, UC Davis, UCSF, UCI and Sutter Sacramento. Each participating site has a CCS-approved Neonatal Intensive Care Unit (NICU). Leaders from the State CCS program, under the direction of Dr. Marian Dalsey, have been active participants in the design, development, and oversight of the project.

Each hospital assigned a project team consisting of a neonatologist, NICU nurse director and an administrator. Behind the scenes, the project team worked with their colleagues in each NICU to implement and monitor the project.

A baseline was established for each facility, and monthly reporting was recorded over the course of nine months. All project participants took part in three in-person meetings and bi-monthly conference calls to share progress and best practices. The project investigators also conducted site visits at all of the participating hospitals' NICUs.

The overarching goal of this collaborative was to show the importance and value of the CCS program, and to demonstrate how access to the CCS program improves care and outcomes. In this way, providers would be helping the CCS program evolve its role from standard setter/regulator/funder to a partner in improving care and clinical services. In order to demonstrate improvement in quality of care, the objective of this collaborative was to reduce the incidence of catheter-related blood stream infections in the NICU, and improve clinical outcomes through implementation of evidence-based clinical processes and best practices. Each participating hospital developed a facility-specific goal that typically ranged from a 25 - 50 percent reduction in infection rates.

Overall, infection rates have been reduced by nearly 29 percent. A reduction in catheter-related blood stream infections in the NICU means that children and their families have reduced lengths of stay, better health outcomes, and it produces significant savings for the payer. It conservatively saves the State and other payers approximately $2 million over the course of a year. Extrapolating from the project's best performance months, post implementation, we could reduce the number of infections by about 83.4 per year, saving the State and other payers approximately $3.4 million annually. While not calculated as part of this project, each hospital's costs of care for these children should also decrease -- potential savings of as much as $190,000 per site per year.