TABLE 1.

Modified Six Sigma Process Used to Develop and Implement the EB-CPM for Febrile Infants

Six Sigma Steps	Actions of the Pediatric Clinical Programs Guidance Council
Define	Identify febrile infants
	• Developed method for identification using electronic administrative data
	• Map the process flow to be improved
	• Created flow diagrams from patient, nursing, laboratory, and physician perspectives
Measure	Develop a data collection plan
	• Developed through iterative process
	Collect data from Intermountain Healthcare facilities
	• Baseline data for all quality measures generated
	• Reports generated for individual facilities and combined target facilities
Analyze	Analyze data collected to determine root causes for defects and sources of variation
	• Baseline data demonstrated poor compliance with laboratory testing with root causes including lack of equipment, laboratory schedules, and courier services
	• Identify and prioritize opportunities for improvement
	• Identify gap between current performance and goal
Improve	Design creative solutions using technology
	• Web-based tools including care algorithms, standard order sets, parent information
	• In-person and web-based training modules
	Develop and deploy implementation plan
	• All target hospitals participated in 2007
Control	Develop and document an ongoing monitoring plan
	• Monitor all quality and balance measures monthly
	• Monitor critical outcomes of febrile infants including deaths and missed SBI
	• Address equipment, laboratory, and courier schedules
	Institutionalize performance by modification of systems and structures
	• Care of febrile infant uses web-based tools available to all providers
	• All hospital representatives receive institutional feedback monthly
	• Hospital representatives inform providers of performance and outcome data
	• Individual provider data for those participating in maintenance of certification