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A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign
Dan L Ellsbury1, Reese H Clark2, Robert Ursprung2
1The Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, Florida dan_ellsbury@pediatrix.com.
Insights
The 100,000 Babies Campaign improved care for critically ill newborns. This quality improvement initiative reduced infant mortality and major morbidities in a large neonatal network.
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Healthcare Systems Engineering
Background:
- Neonatal intensive care units (NICUs) face persistent challenges with infant morbidity and mortality despite medical advances.
- A comprehensive quality improvement initiative, the "100,000 Babies Campaign," was launched to address these issues across a large neonatal network.
Purpose of the Study:
- To achieve large-scale, simultaneous improvements in multiple critical care domains for infants in a neonatal network.
- To implement and evaluate a multifaceted quality improvement program targeting key drivers of neonatal morbidity and mortality.
Main Methods:
- Utilized retrospective morbidity and mortality reviews and staff surveys to identify and prioritize problem areas.
- Reengineered NICU systems in five key driver areas, incorporating the Kotter organizational change model.
- Implemented automated data collection and reporting using electronic health records.
Main Results:
- Analyzed data from over 422,000 infants (including nearly 59,000 low birth weight infants) from 2007 to 2013.
- Achieved significant improvements in key processes like human milk feeding, medication use, ventilator days, and admission temperature (P < .0001).
- Observed reductions in mortality, necrotizing enterocolitis, retinopathy of prematurity, late-onset bacteremia, and catheter-associated infections, alongside improved survival without major morbidities.
Conclusions:
- A multifaceted quality improvement program, integrating organizational change theory and electronic health record data, led to substantial simultaneous improvements in neonatal care processes and outcomes.
- The "100,000 Babies Campaign" demonstrates the effectiveness of a systematic, network-wide approach to enhancing neonatal intensive care.
Background And Objective:
Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the "100,000 Babies Campaign."
Methods:
Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record-based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program.
Results:
From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks' gestation) improved.
Conclusions:
Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record-based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.
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