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Revisions of clinical protocols using the Plan Do Check Act cycle improved outcomes of extremely preterm infants at

Mamoru Saikusa1, Masahiro Kinoshita1, Kennosuke Tsuda1,2

  • 1Department of Paediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan.

Acta Paediatrica (Oslo, Norway : 1992)
|March 12, 2021
PubMed

Insights

Iterative protocol revisions significantly improved outcomes for preterm infants. This quality improvement approach enhanced infant survival and reduced serious adverse events through systematic changes.

Area of Science:

  • Neonatal Medicine
  • Clinical Quality Improvement
  • Pediatric Healthcare

Background:

  • Established clinical protocols can hinder quality improvement initiatives.
  • Systematic revisions are needed to optimize care for vulnerable populations.

Purpose of the Study:

  • To evaluate the impact of iterative protocol revisions on the outcomes of preterm infants.
  • To determine if a Plan-Do-Check-Act (PDCA) cycle approach improves neonatal care quality.

Main Methods:

  • Retrospective analysis of preterm infants (<28 weeks gestation) from 2006-2015.
  • Implementation of protocol changes in 2008 and 2012 using PDCA cycles.
  • Comparison of adverse outcomes (death, motor/sensory impairments) before and after protocol revisions.

Main Results:

  • Adverse outcomes were significantly reduced in the periods following protocol changes (2008-2011 and 2012-2015) compared to the baseline (2006-2007).
  • Specific changes included adjustments to surfactant, nutrition, respiratory support, and early infant stabilization.
  • Statistical significance was achieved for outcome improvements in both post-revision periods (p=0.013 and p=0.035).

Conclusions:

  • Bottom-up, iterative protocol revisions tailored to local settings can effectively improve preterm infant outcomes.
  • Continuous quality improvement cycles are crucial for optimizing neonatal intensive care.
Abstract

Keywords:
extremely preterm infantintact survivalneonatal intensive careoutcome and Plan Do Check Act cycle

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