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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence
Roopali Bapat1, Leif Nelin1,2, Edward Shepherd1
1Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
A quality improvement initiative successfully reduced bronchopulmonary dysplasia (BPD) rates in premature infants by optimizing oxygen and ventilation strategies. This approach significantly decreased both any BPD and severe BPD incidence in a level IV NICU.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Quality Improvement Science
Background:
- Bronchopulmonary Dysplasia (BPD) is a primary complication of prematurity.
- Existing BPD prevention strategies have limited individual effectiveness.
Purpose of the Study:
- To implement and evaluate a multidisciplinary quality improvement (QI) initiative to reduce BPD rates.
- To focus on optimizing oxygen management and noninvasive ventilation strategies for premature infants.
Main Methods:
- Development and implementation of best practice guidelines for oxygen and ventilation.
- Utilized Shewhart control charts to monitor outcome measures.
- Employed Plan-Do-Study-Act (PDSA) cycles for protocol refinement and large-scale rollout.
Main Results:
- The "0.21 by 28" campaign initiated in 2014 led to a significant reduction in "any BPD" and severe BPD (from 57% to 29%).
- Reinvigoration of the project in late 2017 resulted in further decreases, achieving 41% for "any BPD" and 21% for severe BPD.
Conclusions:
- A focused, multidisciplinary QI initiative targeting BPD's pathophysiological drivers can effectively reduce its incidence.
- The implemented strategies demonstrate sustained success in lowering BPD rates within a level IV NICU setting.
Background:
Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD.
Methods:
Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts.
Results:
PDSAs of protocols preceded a large-scale rollout of a "0.21 by 28" campaign in 2014 leading to a special cause reduction in the "any BPD" rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the "any BPD" rate to 41% and the "severe BPD" rate to 21%.
Conclusions:
A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.
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