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Successful implementation of an intracranial hemorrhage (ICH) bundle in reducing severe ICH: a quality improvement

Nicolas Chiriboga1, Josef Cortez2, Adriana Pena-Ariet1

  • 1Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|October 24, 2018
PubMed

Insights

A quality improvement initiative significantly reduced severe intracranial hemorrhage (ICH) in preterm infants. The implementation of an ICH bundle in the neonatal intensive care unit (NICU) lowered the incidence of severe ICH by over 50%.

Area of Science:

  • Neonatal Medicine
  • Pediatric Neurology
  • Quality Improvement Science

Background:

  • Severe intracranial hemorrhage (ICH) is a significant concern in preterm infants (<30 weeks' gestation).
  • Baseline incidence of severe ICH was 24% between January 2012 and December 2013.
  • A need existed to implement effective interventions to reduce ICH rates in this vulnerable population.

Purpose of the Study:

  • To reduce the incidence of severe ICH in preterm infants.
  • To achieve a long-term average ICH rate of 11% by December 2015.
  • To evaluate the effectiveness of a multidisciplinary quality improvement initiative.

Main Methods:

  • Implementation of an ICH bundle including "golden hour" elements (delayed cord clamping, optimized resuscitation, improved thermoregulation) and clustered care.
  • Utilized quality improvement (QI) cycles focusing on bundle initiation, staff education, and sustained adherence.
  • Employed statistical process control analysis (p-chart) to monitor ICH rates.

Main Results:

  • Severe ICH (grade 3-4) incidence decreased from 24% to a sustained average of 9.7% by December 2017.
  • Achieved sustained improvement beyond the initial 2014-2015 goal.
  • Observed improved admission temperatures and a significant decrease in mortality rates (14% to 6%).

Conclusions:

  • A multidisciplinary QI initiative effectively reduced severe ICH in preterm infants.
  • Sustained implementation of the ICH bundle protocol led to a clinically significant reduction in severe ICH.
  • The intervention demonstrated positive impacts on infant temperature and mortality.
Abstract

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