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Clinical process improvement: reduction of pneumothorax and mortality in high-risk preterm infants
M Whit Walker1, Mike Shoemaker, Kim Riddle
1The Children's Hospital, Greenville Hospital System, Greenville, SC 29605, USA.
Insights
Implementing evidence-based, multidisciplinary process improvements in a neonatal intensive care unit (NICU) significantly reduced pneumothorax incidence and mortality in premature infants.
Area of Science:
- Neonatal Medicine
- Clinical Process Improvement
- Evidence-Based Medicine
Background:
- Pneumothorax is a significant risk for premature infants (<28 weeks gestation).
- Existing methods for prevention require optimization.
Purpose of the Study:
- To develop and implement multidisciplinary clinical process improvement methods.
- To decrease the incidence of pneumothorax in a neonatal intensive care unit (NICU).
Main Methods:
- A historical control group of 79 infants (<28 weeks gestation) was established.
- A prospective protocol using evidence-based medicine and rapid-cycle improvement was implemented for subsequent infants.
- The incidence of pneumothorax was measured in 60 consecutive infants in the study group.
Main Results:
- The incidence of pneumothorax decreased significantly from 26.6% in the control group to 10% in the study group (p=0.018).
- Mortality also significantly reduced from 36.7% to 15% (p=0.007).
- No adverse effects were observed in other measured outcome variables.
Conclusions:
- Multidisciplinary clinical process improvement methods are effective in reducing adverse outcomes.
- Implementing evidence-based strategies can improve care for premature infants in the NICU.
Objective:
To develop multidisciplinary clinical process improvement methods using evidence-based medicine to decrease the incidence of pneumothorax in a NICU.
Study Design:
All inborn infants <28 weeks' gestation (n=79) served as the historical baseline group. A prospective protocol, using evidence-based medicine and a rapid-cycle, multidisciplinary clinical process improvement method, was designed to measure changes in the incidence of pneumothorax in subsequent infants of similar gestational ages.
Results:
Sixty consecutive inborn infants <28 weeks' gestational age comprised the study group. In comparison to the historical control group, there was a significant reduction in the incidence of pneumothorax (from 26.6% to 10%, p=0.018) and in mortality (36.7% to 15%, p=0.007) without adversely affecting any other measured outcome variable.
Conclusions:
Introduction of multidisciplinary clinical process improvement methods can significantly decrease the incidence of adverse outcomes in neonatal intensive care units.