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Published on: January 12, 2018
Perinatal excellence to reduce injury in preterm birth (PERIPrem) through quality improvement
Alessandra Glover Williams1, Sam Tuvey2, Hayley McBain2
1Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK alessandra.glover1@nhs.net.
Insights
The Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) care bundle improved preterm infant outcomes, increasing implementation by 26%. This initiative also enhanced team function and communication in perinatal care settings.
Area of Science:
- Neonatal care
- Perinatal medicine
- Quality improvement in healthcare
Background:
- Preterm infants face variable care due to regional differences and implementation gaps in evidence-based treatments.
- Optimizing care for preterm infants is complex, influenced by gestation and local policies.
- The National Health Service (NHS) Long Term plan aims to improve outcomes for preterm babies.
Purpose of the Study:
- To implement the Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) care bundle.
- To reduce severe brain injury and death in preterm infants by at least 50%.
- To improve psychological safety and team-working within perinatal care teams.
Main Methods:
- Development and implementation of an 11-element perinatal care bundle (PERIPrem) using quality improvement (QI) methodology.
- Collaboration between 12 NHS Trusts, Academic Health Science Networks, a Neonatal Operational Delivery Network, parents, and clinical experts.
- Baseline audit to identify regional variations in care element uptake.
Main Results:
- Improved PERIPrem element implementation by 26% (from 3% to 29%) between 2019 and 2021.
- Significantly higher likelihood of receiving the full bundle in 2021 compared to 2019 (probability=0.96).
- Demonstrated improvements in team function (p=0.021), situation monitoring (p=0.029), and communication (p=0.002).
Conclusions:
- The PERIPrem care bundle successfully enhanced the implementation of evidence-based practices for preterm infants.
- The collaborative approach fostered improvements in perinatal team dynamics, including psychological safety and teamwork.
- PERIPrem contributes to reducing mortality and morbidity in preterm infants, promoting disability-free lives.
Abstract:
Perinatal Excellence to Reduce Injury in Premature Birth (PERIPrem) is an 11-element perinatal care bundle designed to improve outcomes for preterm babies, in line with the National Health Service (NHS) Long Term plan. Designed in collaboration with 12 NHS Trusts (secondary care hospitals), South West and West of England Academic Health Science Networks, South West Neonatal Operational Delivery Network, parent partners and clinical experts, implementation was via bespoke quality improvement (QI) methodology. Before project initiation, there was regional variation in uptake of elements, evidenced by baseline audit. Optimisation of the preterm infant is complex; eligibility for treatments is dependent on gestation and local policies. Preterm infants experience variability in care dependent on the place of birth, and there remains an implementation gap for several effective, evidence-based treatments.The PERIPrem ambition is to reduce severe brain injury and death caused by prematurity by at least 50% through the delivery of a perinatal care bundle. The PERIPrem approach resulted in improved element implementation by 26% (from 3% to 29%) between 2019 and 2021, with dyads significantly more likely to receive the full bundle in 2021 compared with 2019 (probability=0.96 (95% CI 0.87 to 0.99), p<0.001). When examining the impact on psychological safety and team-working of PERIPrem, linear mixed models indicated an improvement in team function (p=0.021), situation monitoring (p=0.029) and communication within teams (p=0.002). Central to success was the development of a committed multiorganisational collaborative that continues to drive perinatal improvement using a common language and streamlining processes. In addition to saving the lives of the most vulnerable babies, PERIPrem aims to improve the chances of disability-free lives and is successfully nurturing high-functioning perinatal teams with enhanced QI skills.
