Reinventing the Clinical Audit in a Pediatric Oncology Network

Providing equal access to pediatric cancer patients regardless of their geographic location is a major goal of the Affiliate Program at St. Jude Children's Research Hospital (St. Jude). Thirty-five percent of new cancer patients enrolled on St. Jude clinical trials reside in the communities of 1 of the 8 affiliate clinics, which serve 9 states in the Southeast and Midwest United States. The affiliate clinics support participant recruitment for clinical trials and the geographic extension of St. Jude clinical care. To ensure high-quality pediatric cancer care, we instituted on-site clinical audits, however, we did not see improvement in clinical outcomes including the time to antibiotics in febrile immunocompromised patients, consistent hand-off communication, consistent documentation of oral chemotherapy, and adherence to a central line bundle in the ambulatory setting. We then moved to a more comprehensive clinical audit which involved self-reflection of clinic staff members, transparent data sharing, development of local quality champions, and engagement of senior leaders. The comprehensive approach was more successful in improving clinical outcomes including the time to antibiotics, hand-off communication, documentation of oral chemotherapy administration, and adherence to a central line bundle in the ambulatory setting.